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What matters when managing childhood fever in the emergency department? A discrete-choice experiment comparing the preferences of parents and healthcare professionals in the UK

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Leigh, Simon, Robinson, Jude, Shunmay, Yeung, Coenen, Frans, Enitan, Carrol D and Niessen, Louis ORCID: https://orcid.org/0000-0002-8639-5191 (2020) 'What matters when managing childhood fever in the emergency department? A discrete-choice experiment comparing the preferences of parents and healthcare professionals in the UK'. Archives of Disease in Childhood, Vol 105, Issue 8, pp. 765-771.

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Abstract

Background Fever among children is a leading cause of emergency department (ED) attendance and a diagnostic conundrum; yet robust quantitative evidence regarding the preferences of parents and healthcare providers (HCPs) for managing fever is scarce.
Objective To determine parental and HCP preferences for the management of paediatric febrile illness in the ED.
Setting Ten children’s centres and a children’s ED in England from June 2018 to January 2019.
Participants 98 parents of children aged 0–11 years, and 99 HCPs took part.
Methods Nine focus- groups and coin- ranking exercises were conducted with parents, and a discrete- choice experiment (DCE) was conducted with both parents and HCPs, which asked respondents to choose their preferred option of several hypothetical management scenarios for paediatric febrile illness, with differing levels of visit time, out- of- pocket costs, antibiotic prescribing, HCP grade and pain/discomfort from investigations.
Results The mean focus- group size was 4.4 participants (range 3–7), with a mean duration of 27.4 min (range 18–46 min). Response rates to the DCE among parents and HCPs were 94.2% and 98.2%, respectively. Avoiding pain from diagnostics, receiving a faster diagnosis and minimising wait times were major concerns for both parents and HCPs, with parents willing- to- pay £16.89 for every 1 hour reduction in waiting times. Both groups preferred treatment by consultants and nurse practitioners to treatment by doctors in postgraduate training. Parents were willing to trade- off considerable increases in waiting times (24.1 min) to be seen by consultants and to avoid additional pain from diagnostics (45.6 min). Reducing antibiotic prescribing was important to HCPs but not parents.
Conclusions Both parents and HCPs care strongly about reducing visit time, avoiding pain from invasive investigations and receiving diagnostic insights faster when managing paediatric febrile illness. As such, overdue advances in diagnostic capabilities should improve child and carer experience and HCP satisfaction considerably in managing paediatric febrile illness.

Item Type: Article
Subjects: WB Practice of Medicine > Diagnosis > General Diagnosis > WB 152 Chills. Fever
WS Pediatrics > WS 100 General works
WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 141 Physical examination. Diagnosis. Mass screening. Monitoring
WX Hospitals and Other Health Facilities > Clinical Departments and Units > WX 200 General works
WX Hospitals and Other Health Facilities > Clinical Departments and Units > WX 215 Emergency service. Ambulance service
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/archdischild-2019-318209
Depositing User: Tina Bowers
Date Deposited: 28 Feb 2020 11:58
Last Modified: 22 Jul 2020 11:44
URI: https://archive.lstmed.ac.uk/id/eprint/13730

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