Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study (Preprint)

Abstract

BACKGROUND Parents identify expectations of telemedicine for acute pediatric care. OBJECTIVE To examine parental expectations of telemedicine for acute pediatric care, contrasting expectations of telemedicine delivered by primary care practices and telemedicine delivered by commercial direct-to-consumer companies. METHODS We performed a sequential mixed-methods study to examine how parents view telemedicine for their children’s acute care. First, we used semi-structured interviews to identify factors affecting parental perceptions of telemedicine in the context of care-seeking for a child’s acute respiratory symptoms. We then analyzed the interviews using an existing seven-dimension framework of parental health care-seeking. Second, we developed and fielded a national survey informed by the interview results, inquiring specifically about parental expectations of primary care telemedicine and commercial direct-to-consumer telemedicine as well as three in-person sites of care (primary care, urgent care, and emergency department). We compared survey responses for primary care telemedicine and commercial direct-to-consumer telemedicine using weighted logistic regression. RESULTS Interview participants (n=40) identified multiple factors affecting their perceptions of telemedicine as a care modality for their children, aligning with each of the seven dimensions in the parent health care-seeking framework. Generally, factors aligned with access and affordability (e.g., decreased wait time, lower out of pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility and clinician quality (e.g., trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial direct-to-consumer telemedicine were rated similarly on items related to access and affordability. In contrast, on items related to quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial direct-to-consumer telemedicine was rated lower. (69.7% of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% with commercial direct-to-consumer telemedicine, p<0.001). CONCLUSIONS In a mixed methods analysis of acute care telemedicine, parents expressed more concerns about telemedicine quality in commercial direct-to-consumer models compared to primary care-based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.