Understanding Use of Direct to Consumer Telemedicine for Pediatric Acute Respiratory Infections - Pediatric acute respiratory infections (ARIs) account for over 30% of outpatient visits by young
children and for over 50% of the outpatient visits that result in antibiotic prescriptions. Many ARIs are
viral and self-limited, yet visits even for viral ARIs frequently result in unnecessary antibiotic use,
leading to antibiotic resistance, treatment side effects, and health care spending exceeding $17 billion
annually. As a result, efforts to limit unnecessary ARI visits and reduce unnecessary ARI antibiotic
use are a high priority for the US health care system. These efforts face a new challenge in the
emergence of direct-to-consumer (DTC) telemedicine as a care option for pediatric ARIs. By enabling
access to care “anywhere, anytime,” DTC telemedicine offers improved timeliness and accessibility,
but is also associated with increased volume of ARI visits and more unnecessary antibiotic use. With
the new option of DTC telemedicine, parents must navigate several care options, each with potential
gains and losses in quality domains relative to alternatives. Yet little is known about how parents
approach tradeoffs in perceived quality in general and with DTC telemedicine specifically when
making decisions about ARI care-seeking. The overall goal of this proposal is to address this critical
knowledge gap by developing a comprehensive understanding of care-seeking decisions for pediatric
ARIs in the context of DTC telemedicine. In Aim 1, we will use rigorous decision science methods to
identify the “mental models” that parents use when making decisions about seeking care for a child’s
ARI via DTC telemedicine versus other options. In Aim 2 we will employ robust quantitative methods
to identify patient, family, and health system factors associated with use of DTC telemedicine for ARIs
in national commercial claims data, complementing our micro-level examination of parent decision
making with this macro-level examination of patterns of care. In Aim 3 we will examine parent tradeoff
thresholds for specific attributes of acute care models through a discrete choice experiment. This aim
will integrate the findings from our first two aims, asking parents to choose between pairs of care
options with varying levels of key attributes (identified in Aim 1), allowing identification of preferences
and willingness-to-trade thresholds for the full sample and for subgroups with differential use of DTC
telemedicine for ARIs (identified in Aim 2). This project will apply rigorous decision science tools to
DTC telemedicine, which is being rapidly adopted for pediatric ARIs without adequate understanding
of its impact on care-seeking decisions. Together, these aims will provide critical insight into care-
seeking decisions when priorities conflict (e.g., timeliness vs. safety) thereby informing future decision
support tools, intervention design and evaluation, and payer and policy-maker decisions related to
DTC telemedicine for pediatric ARIs.
