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Published on: September 19, 2019
How parents express their worry in calls to a medical helpline: a mixed methods study
Caroline Gren1,2, Maria Kjøller Pedersen3, Asbjørn Børch Hasselager4
1Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark. ida.caroline.gren.02@regionh.dk.
Insights
Parental worry in pediatric calls can predict severe illness. Addressing parental concerns and providing reassurance during telephone triage is crucial for effective out-of-hours primary care.
Area of Science:
- Pediatric Healthcare
- Emergency Medicine
- Health Services Research
Background:
- Telephone triage is a global standard in out-of-hours primary care for prioritizing urgent assessments.
- Pediatric calls are frequent in telephone triage, often driven by parental concern rather than severe illness.
- Call-handlers face challenges in pediatric triage due to reliance on parental second-hand information.
Purpose of the Study:
- To determine if parental worry predicts severe illness in pediatric telephone triage.
- To explore variations in call content based on parental worry levels.
- To enhance the effectiveness of pediatric telephone triage systems.
Main Methods:
- Convergent mixed-methods study design.
- Quantitative analysis of parental worry, triage decisions, and patient outcomes in 2857 pediatric calls.
- Qualitative analysis of 54 calls involving hospitalization for ≥24 hours.
Main Results:
- High parental worry was significantly associated with hospitalization ≥24 hours (OR 3.33).
- Worry, often triggered by loss-of-control, was the primary reason for calls.
- High worry calls frequently involved recent healthcare contact; low worry calls suggested early disease stages.
Conclusions:
- Parental worry is a valuable indicator of potentially severe illness in pediatric telephone triage.
- Call-handlers should focus on reassurance and regaining parental control to prevent unnecessary repeat contacts.
- Implementing parental worry scoring can improve global out-of-hours pediatric care and safety netting.
Background:
Telephone triage is used globally in out-of-hours primary care, to prioritize who needs urgent assessment. Even though children rarely are severely ill, calls about sick children are among the most prevalent, mainly due to parental worry. Pediatric calls are considered challenging, as the call-handler must rely on parents' second-hand information. We aimed to investigate if parents' worry can be used as a predictor of severe illness, and if the content of the calls varies between different grades of worry.
Methods:
In a convergent mixed methods study design we asked patients to rate their degree-of-worry before talking to a call-handler. We used quantitative data of degree-of-worry, triage- and patient outcome in pediatric calls (n = 2857), and the qualitative content from 54 calls with subsequent hospitalization ≥24 h.
Results:
High degree-of-worry was associated with hospitalization ≥24 h (OR 3.33, 95% CI 1.53-7.21). Qualitative findings both confirmed and expanded knowledge of degree-of-worry. Worry was the predominant cause for contact overall, and was mainly triggered by loss-of-control. In calls with high degree-of-worry, the prevalence of loss-of-control was especially high, and the parents had additionally often contacted healthcare services recently. Parents with a foreign accent often rated their worry as high, and these callers were often ignored or interrupted. Calls with low degree-of-worry seemed to occur early during the disease.
Conclusion:
High degree of parental worry was associated with severe illness. At the end of calls, call-handlers should ensure that the parent has regained control of the situation to reach increased reassurance and to prevent renewed unnecessary contact. Safety-netting is crucial, as many parents made contact early during the illness and deterioration may develop later. The scoring of parental degree-of-worry may be used as an indicator of potentially severe illness and can easily be implemented at out-of-hours call-centers globally.
Trial Registration:
Original study registered at clinicaltrials.gov ( NCT02979457 ).
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