After-hours telephone triage and advice in private and nonprivate pediatric populations.

OBJECTIVES: To compare the content of after-hours medical triage and advice calls regarding private practice patients vs nonprivate practice patients and to assess caregiver compliance with advice resulting from these calls. DESIGN: Survey of after-hours medical triage and advice calls during a 2-week period (September 1 through 15, 1996). SETTING: Three private practices (serving approximately 24 000 patients) and 1 urban hospital-based, non-private practice (serving approximately 12 000 patients). SUBJECTS: After-hours medical triage and advice calls from caregivers of patients receiving their primary care in these settings. MAIN OUTCOME MEASURE: Compliance with recommended emergency department (ED) or office visit referrals. RESULTS: A total of 286 calls regarding private practice patients and 377 calls regarding nonprivate practice patients were received (P<.001). Eighty-one calls were referred by the nurse directly to the physician. Fifty-nine private practice patients and 59 nonprivate practice patients were referred to the ED. Caregivers of 94 private practice patients and 132 nonprivate practice patients were given home treatment advice. Appointments to be seen at their primary care source were given for 78 private practice patients and 160 nonprivate practice patients. Non-private practice patients were more likely to be referred for office care (P=.005); private practice patients were more likely to be referred to the ED (P=.01). Compliance with ED referrals was 42% for patients of nonprivate practice and 46% for private practice; for office visit referrals, compliance was 64% for nonprivate practice and 69% private practice patients (P=.71 for compliance with ED referrals and P=.40 for compliance with office referrals). CONCLUSIONS: Compliance with recommended physician encounters was not significantly different (and lower than expected) in both groups of patients. Private practice patients are more likely to be referred to the ED. Calls for nonprivate practice patients are more frequent and these patients are more likely to be referred to their primary care source. This difference may be due to caregivers of patients from nonprivate practices seeking advice for less serious conditions. Physicians should address telephone medicine with caregivers proactively during health maintenance visits.

Mannitol and glucose: effects on gastric acid secretion and endogenous gastric inhibitory polypeptide (GIP).

Serum gastric inhibitory polypeptide was measured in dogs prepared with Heidenhain pouches and Mann-Bollman fistulae following the intraduodenal (ID) infusion of isotonic saline, 20% glucose, or 20% mannitol. Following ID 20% glucose, serum GIP concentrations rose significantly (P less than 0.05) between 30 and 120 min and there was a significant inhibition (P less than 0.05) of acid secretion in the Heidenhain pouches between 15 and 75 min. A good correlation (r = 0.925) was found between the rise in serum GIP and the inhibition of acid secretion. Although neither ID isotonic saline nor 20% mannitol stimulated GIP release, the latter produced a significant (P less than 0.05) inhibition of acid secretion between 60 and 105 min. We conclude: (1) the inhibitory effect of acid secretion following ID glucose is mediated in part by the release of endogenous GIP; (2) glucose and mannitol probably inhibit gastric acid secretion by different mechanisms.