After-Hours Telephone Use in Urban Pediatric Primary Care Centers

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.