Presentation (CTI)

OBJECTIVES: Respiratory tract infections (RTIs) are a leading cause of antibiotic prescribing in children, despite many being self-limiting. While antimicrobial stewardship has traditionally focused on clinician behaviour, parental decision-making plays a role in shaping healthcare use and treatment choices. These decisions can be made under uncertainty and influenced by access, cost, prior experience, and the need for reassurance. This study aimed to quantify parental preferences for healthcare pathways and antibiotic prescribing.
METHODS: A discrete choice experiment was conducted among parents in Ireland (n=469). Participants completed 12 choice tasks, selecting between two hypothetical healthcare options and an opt-out. Attributes included waiting time, provider type, antibiotic prescribing strategy, advice, and cost. Data were analysed using alternative-specific conditional logit models. Willingness-to-pay estimates were derived, and pre-specified interaction terms were used to explore observed preference heterogeneity.
RESULTS: Parents demonstrated strong preferences for shorter waiting times, GP-led care, and lower out-of-pocket costs. Utility decreased with increasing waiting time, with the greatest disutility observed for delays of 72 hours. Relative to no antibiotic prescribing, both immediate (β=0.78, p<0.001) and delayed (β=0.47, p<0.001) prescribing were positively associated with choice. Provision of self-care advice with when-to-worry guidance also increased utility (β=0.54, p<0.001). Non-GP providers were associated with lower utility, particularly pharmacist-led care (β=−0.78, p<0.001). Cost was negatively associated with utility (β=−0.016, p<0.001). Interaction analyses indicated that subsidised healthcare status modified cost sensitivity, prior antibiotic experience influenced provider preferences, and education level affected antibiotic-related preferences.
CONCLUSIONS: Parental preferences for healthcare pathways in childhood RTIs are shaped by structural and behavioural factors. While antibiotics were positively valued, advice provision and delayed prescribing also contributed substantially to utility, suggesting that antibiotic demand may reflect responses to uncertainty and perceived risk rather than a fixed preference for medication. Interventions that reduce uncertainty and enhance reassurance may support antimicrobial stewardship without undermining parental confidence in care.