Childhood fever: a qualitative study on GPs' experiences during out-of-hours care

Fam Pract. 2015 Aug;32(4):449-55. doi: 10.1093/fampra/cmv029. Epub 2015 Apr 25.


Background: Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations.

Objective: To describe GPs' experiences regarding management of childhood fever during out-of-hours care.

Methods: A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding.

Results: Main categories were: (i) Workload and general experience; (ii) GPs' perceptions of determinants of consulting behaviour; (iii) Parents' expectations from the GP's point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time-pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging.

Conclusion: Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking long-term relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.

Keywords: Antibiotics; child; family practice; infection; primary health care; qualitative research..

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • After-Hours Care / statistics & numerical data*
  • Female
  • Fever / diagnosis*
  • Fever / therapy
  • Focus Groups
  • General Practitioners / psychology*
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Netherlands
  • Parents
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Qualitative Research
  • Referral and Consultation
  • Workload*