ABSTRACT
Hong Kong Med J 2013;19:6–12 | Number 1, February 2013
ORIGINAL ARTICLE
Fever as a predictor of doctor shopping in the paediatric population
Keith W Hariman, Stacey C Lam, Yvette WS Lam, Karen HK Luk, KK Poon, Albert M Li
Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
OBJECTIVES. To estimate prevalence and assess factors associated with doctor shopping among caregivers of children acutely admitted to a hospital in Hong Kong, and examine the reasons for such behaviour and caregivers’ awareness of its possible dangers.
DESIGN. Cross-sectional study with face-to-face surveys.
SETTING. A paediatric unit in a teaching hospital in Hong Kong.
PARTICIPANTS. Caregivers of children admitted to acute paediatric wards between April and July 2011.
MAIN OUTCOME MEASURES. Socio-demographic characteristics of the interviewee, personal history and clinical data of the patient, presence of doctor shopping (consulting more than one doctor for medical advice without referral) for each episode, the reasons behind such behaviour, and awareness of potential dangers. Data retrieved were analysed to estimate the prevalence and logistic regression was used to assess factors associated with doctor shopping.
RESULTS. In all, 649 such patients were admitted into hospital during the study period, of which 336 were recruited, with about a half being absent or given home leave. Thirty-four patients were excluded due to absent caregivers or refusal, and 302 were included in the study. More than half (79.5%) were female and the caregivers’ monthly household incomes were between HK$10 001 and HK$15 000 (21.2%), similar to the median household income in Hong Kong. The prevalence of doctor shopping was 53%. The only significant clinical parameter associated with doctor shopping was presence of fever (odds ratio=2.4; 95% confidence interval, 1.4-3.9). Persistence of symptoms was the commonest reason given by interviewees for doctor shopping, and the majority (75.5%) were unaware of the possible dangers of this behaviour.
CONCLUSION. Doctor shopping is highly prevalent among caregivers of children with acute paediatric conditions. Most caregivers do not know the potential complications of this behaviour. Further measures should be taken to educate subjects on the associated dangers of this behaviour and the natural course of acute illnesses with fever.
Key words:Awareness; Child; Continuity of patient care; Education; Fever
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