Policy of free GP care for children under 6 years: The impact on emergency department attendance

Factors that affect GP referral of a child with intellectual disability for a mild illness: A discrete choice experiment

BACKGROUND

General practitioners (GP) report multiple challenges when treating individuals with intellectual disabilities which may influence referral rates. The study aimed to establish factors that influence GP's decision-making when referring a child with intellectual disabilities to the emergency department.

METHOD

Discrete choice experiments (DCEs) are increasingly used in health research to further understand complex decision making. A DCE was designed to assess the relative importance of factors that may influence a GP's (N = 157) decision to refer.

RESULTS

A random parameters model indicated that perceived limited parental capacity to manage an illness was the most important factor in the decision to refer a child to the ED, followed by a repeat visit, a referral request from the parent, and a Friday afternoon appointment.

CONCLUSION

Understanding the factors that influence referral is important for service improvement and to strengthen primary care provision for this population and their families.

Parent's preferences for unscheduled paediatric healthcare: A discrete choice experiment

BACKGROUND

Unscheduled healthcare is a key component of healthcare delivery and makes up a significant proportion of healthcare access, with children being particularly high users of unscheduled healthcare. Understanding the relative importance of factors that influence this behaviour and decision-making is fundamental to ensuring the system is best designed to meet the needs of users and foster appropriate cost-effective usage of health system resources.

OBJECTIVE

The aim of the study was to identify the parent's preferences for unscheduled healthcare for a common mild childhood illness.

DESIGN

A discrete choice experiment (DCE) was developed to identify the preferences of parents accessing unscheduled healthcare for their children.

SETTING AND PARTICIPANTS

Data were collected from parents in Ireland (N = 458) to elicit preferences across five attributes: timeliness, appointment type, healthcare professional attended, telephone guidance before attending and cost.

RESULTS

Using a random parameters logit model, all attributes were statistically significant, cost (β = -5.064, 95% confidence interval, CI [-5.60, -4.53]), same-day (β = 1.386, 95% CI [1.19, 1.58]) or next-day access (β = 0.857, 95% CI [0.73, 0.98]), coupled with care by their own general practitioner (β = 0.748, 95% CI [0.61, 0.89]), identified as the strongest preferences of parents accessing unscheduled healthcare for their children.

DISCUSSION

The results have implications for policy development and implementation initiatives that seek to improve unscheduled health services as understanding how parents use these services can maximise their effectiveness.

PATIENT OR PUBLIC CONTRIBUTION

The development of the DCE included a qualitative research component to ensure that the content accurately reflected parents experiences when seeking healthcare. Before data collection, a pilot test was carried out with the target population to gather their views on the survey.