Parent Preferences for Acute Respiratory Tract Infection Care

Care is commonly sought for pediatric acute respiratory tract infections (ARTIs). The site where families seek ARTI care affects continuity, quality, and costs, but how parents of young children balance tradeoffs between care sites is unknown. To evaluate preferences for attributes of ARTI care sites among parents of young children using a discrete choice experiment (DCE). This survey study using a DCE was conducted among a nationally representative panel of US parents of children aged 6 months to 5 years between July 31 and August 18, 2023. Participants completed a DCE survey with 7 care attributes (visit modality, visit timeliness, noncare time, out-of-pocket costs, clinician continuity, pediatric expertise, and follow-up availability), with 2 to 5 levels each. The DCE used standard choice-based conjoint procedures. Sawtooth software was used to create a random, balanced overlap experimental design. Data were analyzed between October 2023 and October 2024. The main outcomes were preferences for attributes and their levels, examined using hierarchical bayesian and latent class analyses and market simulation of care choices under different scenarios. Of 944 respondents, 63 (6.7%) self-identified as Asian or Pacific Islander, 228 (24.2%) as Hispanic, 120 (12.8%) as Black non-Hispanic, 501 (53.1%) as White non-Hispanic, and 30 (3.3%) as other non-Hispanic; 53% were women; 285 spoke a language other than English at home; and 338 had children who received Medicaid. Respondents' mean (SD) age was 36.5 (7.4). Overall, respondents gave most weight to visit modality (in person vs telemedicine; importance, 22.7%) and out-of-pocket costs (importance, 23.7%) and least weight to noncare time (importance, 5.8%) and availability of follow-up within 2 days (importance, 6.8%). Latent class analysis identified 4 subgroups: urgency focused (47.4% of respondents), continuity focused (22.7%), cost focused (20.6%), and in-person visit focused (9.3%). The addition of a telehealth visit option with the child's usual primary care practice available within 30 minutes to options of in-person primary care, urgent care, and emergency department care shifted reduced anticipated care seeking outside of primary care in urgency-focused (-13.3%) and cost-focused (-5.6%) subgroups and reduced forgone care in the cost-focused subgroup (-8.1%). In this survey study using a DCE, a subset of parents prioritized in-person care for pediatric ARTI care, and most parents had other profiles focused on different care attributes. Results of this research suggest that access to low-cost, quickly available telehealth services with a clinician in a child's usual practice could shift some urgent care and emergency department visits for ARTI to the child's primary care practice.