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

Leigh, S., Robinson, J. , Yeung, S., Coenen, F., Carrol, E. D. and Niessen, L. W. (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, 105(8), pp. 765-771. (doi: 10.1136/archdischild-2019-318209) (PMID:32107251) (PMCID:PMC7392496)

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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:Articles
Additional Information:SL is funded by a studentship from the Institute of Infection and Global Health, The University of Liverpool and the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 668303 (PERFORM study (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union).
Keywords:Original research, 1506, infectious diseases, qualitative research, discrete choice experiment, paediatrics, emergency care.
Glasgow Author(s) Enlighten ID:Robinson, Professor Jude
Authors: Leigh, S., Robinson, J., Yeung, S., Coenen, F., Carrol, E. D., and Niessen, L. W.
College/School:College of Social Sciences > School of Social and Political Sciences
Journal Name:Archives of Disease in Childhood
Publisher:BMJ Publishing Group
ISSN (Online):1468-2044
Published Online:27 February 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Archives of Disease in Childhood 105(8): 765-771
Publisher Policy:Reproduced under a Creative Commons licence

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