Associate Professor of Pediatrics University of Pittsburgh Pittsburgh, Pennsylvania, United States
Background: One of the most common reasons for care-seeking in pediatrics are acute respiratory tract infections (ARTI). The site of care that families choose during this process has implications for continuity, quality, and costs. Objective: To understand preferences for attributes of ARTI care sites among parents of young children. Design/Methods: We developed and fielded a discrete choice experiment (DCE) with 7 attributes (visit modality [in-person vs. telemedicine], timeliness of visit, non-care time, out-of-pocket costs, continuity, pediatric-focus, and follow-up availability) with 2 to 5 levels each. Attributes were derived from a prior qualitative study of parent decision making. The DCE was designed using standard choice-based conjoint procedures. Sawtooth software was used to create a random, full-profile, balanced-overlap experimental design. We fielded this DCE to parents of children ages 6 months-5 years within a nationally representative panel of US adults. Participants completed 12 discrete choice tasks with bundled pairs. Analysis was performed with random-parameters multinomial logit and latent class analysis. Results: 40% of individuals completing the screener were eligible, and 95% of those eligible completed the survey, yielding a sample of 944 parents who completed the DCE. Among respondents, 13% identified as Black non-Hispanic and 20% as Hispanic individuals. 36% of respondents indicated that their children were Medicaid beneficiaries and 30% indicated that they spoke a language other than English at home. The sample included respondents from all 50 states and the District of Columbia. Respondents cared most about out-of-pocket costs and visit modality (in-person vs. telemedicine) and cared least about attributes of non-care time and availability of follow-up within two days. Latent class analysis identified two subgroups. The first group (32.8% of respondents, “telehealth avoidant”) was most sensitive to visit modality (importance 33.6%), followed by out-of-pocket costs (24.8%) and pediatric provider (12.0%). The second group (67.2% of respondents, “cost avoidant”) was most sensitive to out-of-pocket costs (importance 25.8%) followed by timeliness of visit (20.4%) and visit modality (18.2%).
Conclusion(s): While a subset of telehealth-avoidant parents prioritized obtaining in-person care for pediatric acute respiratory tract infection care, the majority of parents were instead cost-avoidant and willing to consider telehealth to minimize costs and waits. Understanding the priorities and characteristics of these groups can help health systems better meet family needs around seeking ARTI care.
