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After-hours telephone use in urban pediatric primary care centers
Insights
Pediatric after-hours telephone systems are used similarly across urban health centers and suburban practices. However, health center calls were more often late-night and led to child examinations, with younger children
Area of Science:
- Pediatric healthcare access and utilization
- After-hours care systems
- Communication in healthcare
Background:
- Debate exists on the effectiveness of after-hours telephone systems for families unfamiliar with formal call structures.
- Understanding patient usage patterns is crucial for optimizing after-hours pediatric care delivery.
Purpose of the Study:
- To compare the utilization of after-hours telephone systems between urban pediatric health centers and suburban private practices.
- To analyze the characteristics and outcomes of calls made to these systems.
Main Methods:
- Comparative analysis of call data from two urban pediatric health centers and three suburban private practices.
- Age-adjusted call rates were calculated and analyzed.
- Call timing, reasons for calls, and subsequent actions (e.g., examination) were documented.
Main Results:
- Age-adjusted call rates were comparable across all practice types.
- A higher proportion of calls from health centers occurred late at night and resulted in child examinations.
- Calls concerning younger children and late-night calls were more frequently deemed inappropriate; however, parent satisfaction and communication effectiveness were similar across settings.
Conclusions:
- After-hours telephone systems are utilized with similar overall frequency but differ in timing and outcomes between urban health centers and suburban practices.
- While some late-night calls for younger children may be deemed inappropriate, parents in both settings communicate effectively and report similar satisfaction levels.
- A significant majority (80%) of health center patients appropriately followed established after-hours care pathways.
Abstract:
Controversy exists regarding use of after-hours telephone systems by families unaccustomed to formal call systems. Our study compared the use of these systems by patients from two urban pediatric health centers with that by enrollees from three suburban private practices. The age-adjusted call rates were similar for all practices. However, a significantly higher proportion of health center calls came late at night and resulted in examination of the child. For all practices, call rates varied with age, from 6.0 calls per night per 1,000 patients for infants to 0.2 call per night per 1,000 patients for teenagers. Calls concerning younger children and late-night calls were more frequently judged inappropriate. Parents using health centers communicated their concerns as effectively as those using private practices and were similarly satisfied. Of all health center patients seeking advice after hours, 80% properly followed established pathways.