Unscheduled consultation in pediatric health
DOI:
https://doi.org/10.32385/rpmgf.v41i6.14157Keywords:
Ambulatory care, Infant, Child, Adolescent, Primary health careAbstract
Introduction: The family doctor plays a significant role as the primary responder in cases of acute disease. Given the high demand for unscheduled consultations (UC) in pediatric age groups, it was considered pertinent to characterize UC in a Family Health Unit (FHU). UC were considered those without prior scheduling, intended for the observation of acute disease.
Methods: The sample consisted of UC cases conducted within the pediatric population (<18 years old) in 2022 at the FHU. A retrospective, observational, and descriptive study was conducted, analyzing demographic variables, reasons for consultation, diagnosis, and therapeutic plans. The follow-up of these children at the Child and Youth Health Consultation (CSIJ) was also evaluated. Statistical analysis was performed using SPSS® v. 28.
Results: Out of 1,224 consultations, which occurred at a median age of 6.2 years, 42.0% occurred before school age. Most children had regular follow-up in CYHC, with adolescents aged 14 years and above showing lower follow-up rates. Consultation distribution was not uniform throughout the year, with 39.4% occurring from October to December. Fever (40.6%), along with cough/runny nose (28.5%), were the primary reasons for consultation. The most frequent diagnostic group was respiratory pathology (46.5%), and in most consultations, the plan consisted of general and symptomatic measures (52.4%). Only 6.1% were referred to the hospital emergency service (ES), with 62.7% of these referrals considered appropriate.
Conclusion: UC plays a fundamental role in managing acute disease in the pediatric population, significantly reducing the use of the ES. Most pathologies were respiratory infections, managed solely with symptomatic measures. There is a need to improve follow-up among adolescents and reinforce healthcare teams during the fall/winter seasons. Therefore, this study may serve as a starting point for improving UC response, with better planning and quality of care provided.
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1. Menezes B, Oliveira D, Sassetti L, Prazeres V. Saúde infantil e juvenil: programa nacional [Internet]. Lisboa: Direção-Geral da Saúde; 2013 [cited 2024 Sep]. Available from: https://www.spp.pt/UserFiles/file/Protocolos_Manuais_DGS/Programa_Nacional_Saude_Infantil_Juvenil.pdf
2. ACeS Porto Ocidental. Conceitos de saúde [homepage]. Porto: ACeS Porto Ocidental; s.d. [cited 2025 Jun]. Available from: https://acesportoocidental.org/pt/conceitos-saude
3. Freitas AC, Moreira AR, Tomé S, Cardoso R. Motivos de recurso ao serviço de urgência pediátrica [Reasons to access to a pediatric emergency department]. Nascer Crescer. 2016;25(3):136-40. Portuguese
4. May M, Brousseau DC, Nelson DA, Flynn KE, Wolf MS, Lepley B, et al. Why parents seek care for acute illness in the clinic or the ED: the role of health literacy. Acad Pediatr. 2018;18(3):289-96.
5. Nicholson E, McDonnell T, Hamza M, Barrett M, Brunsdon C, Bury G, et al. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol. HRB Open Res. 2019;2:11.
6. WONCA. Classificação Internacional de Cuidados de Saúde Primários. 2ª ed. Lisboa: Administração Central do Sistema de Saúde; 2011.
7. Greenfield G, Okoli O, Quezada-Yamamoto H, Blair M, Saxena S, Majeed A, et al. Characteristics of frequently attending children in hospital emergency departments: a systematic review. BMJ Open. 2021;11(10):e051409.
8. Ball TM, Holberg CJ, Aldous MB, Martinez FD, Wright AL. Influence of attendance at day care on the common cold from birth through 13 years of age. Arch Pediatr Adolesc Med. 2002;156(2):121-6.
9. Vinagre MG, Barros L. Preferências dos adolescentes sobre os cuidados de saúde [Adolescents' preferences regarding health care]. Cien Saude Colet. 2019;24(5):1627-36. Portuguese
10. Reis FA. Não comparência a consultas médicas, sua caracterização e implicações no acesso aos cuidados de saúde: uma revisão da literatura [dissertation]. Porto: ICBAS - Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto; 2020. Available from: https://hdl.handle.net/10216/128246
11. Neumann G, Kawaoka Y. Seasonality of influenza and other respiratory viruses. EMBO Mol Med. 2022;14(4):e15352.
12. Metz C, Schmid A, Veldhoen S. Increase in complicated upper respiratory tract infection in children during the 2022/2023 winter season: a post coronavirus disease 2019 effect? Pediatr Radiol. 2024;54(1):49-57.
13. Murgia V, Manti S, Licari A, De Filippo M, Ciprandi G, Marseglia GL. Upper respiratory tract infection-associated acute cough and the urge to cough: new insights for clinical practice. Pediatr Allergy Immunol Pulmonol. 2020;33(1):3-11.
14. Peetoom KK, Smits JJ, Ploum LJ, Verbakel JY, Dinant GJ, Cals JW. Does well-child care education improve consultations and medication management for childhood fever and common infections? A systematic review. Arch Dis Child. 2017;102(3):261-7.
15. Turyasiima M, Kiconco G, Egesa WI, Twesigemukama S, Nduwimana M. Prevalence and outpatient clinical diagnostic approaches for common acute respiratory tract infections in children under five years of age: a cross-sectional study. Pediatric Health Med Ther. 2024;15:49-57.
16. Newbould L, Campbell SM, Edwards G, Morris RL, Hayward G, Hughes EC, et al. Respiratory infections in children: an appropriateness study of when parents should home care or seek medical help. Br J Gen Pract. 2021;71(703):e140-7.
17. Fölster-Holst R, Kreth HW. Viral exanthems in childhood-infectious (direct) exanthems. Part 1: classic exanthems. J Dtsch Dermatol Ges. 2009;7(4):309-16.
18. Ramirez DA, Porco TC, Lietman TM, Keenan JD. Epidemiology of conjunctivitis in US emergency departments. JAMA Ophthalmol. 2017;135(10):1119-21.
19. Afonso TM. Otite média aguda nos dois primeiros anos de vida [dissertation]. Lisboa: Faculdade de Medicina da Universidade de Lisboa; 2020. Available from: http://hdl.handle.net/10451/47519
20. Costa e Silva L, Fragoso I, Teles J. Prevalence and injury profile in Portuguese children and adolescents according to their level of sports participation. J Sports Med Phys Fitness. 2018;58(3):271-9.
21. Vale F, Pinto F, Oliveira R, Martins C, Lopes S. Referenciação dos cuidados de saúde primários ao serviço de urgência de pediatria de um hospital nível II: que realidade? [Reference of primary health care to the pediatric emergency department at a level II hospital: what reality?]. Gaz Med. 2021;8(3):179-86. Portuguese
22. Korppi M, Heikkilä P, Palmu S, Huhtala H, Csonka P. Antibiotic prescribing for children with upper respiratory tract infection: a Finnish nationwide 7-year observational study. Eur J Pediatr. 2022;181(8):2981-90.
23. Alexandrino AS, Santos R, Melo C, Bastos JM. Impact of caregivers' education regarding respiratory infections on the health status of day-care children: a randomized trial. Fam Pract. 2016;33(5):476-81.
24. Carvalho I, Ferreira G, Vilarinho A. Análise da referenciação ao serviço de urgência pediátrico [Analysis of pediatric emergency department's referral]. Acta Pediatr Port. 2006;37(3):95-100. Portuguese
25. Pinheiro AP. Referenciação à urgência pediátrica do Hospital S. Teotónio-Viseu [Referral to the pediatric emergency service of S. Teotónio Hospital in Viseu]. Rev Port Clin Geral. 2008;24(6):671-8. Portuguese
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