Article Text
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.
- infectious diseases
- qualitative research
- discrete choice experiment
- paediatrics
- emergency care
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Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
EDC and LWN are joint first authors.
EDC and LWN contributed equally.
Correction notice The paper has been corrected since it was published online. Unfortunately, we published identical figures 1b and 1c and these have been updated. Also, the final two authors (Enitan D Carrol and Louis W Niessen) had are joint first authors and made an equal contribution to the article and this has now been noted on the paper.
Contributors LN and EDC designed and formulated the research question. SL, JR, SY and FC assisted in study design. SL conducted all interviews and surveys, organised the data and conducted analyses. SL, EDC, LN and JR wrote the first draft of the paper. All authors contributed to the final manuscript.
Funding 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).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study received ethical approval from the Health and Life Sciences Research Committee at the University of Liverpool, reference number 3032.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.