Table 4 Study design, methods and factors that influence decision making

Albrecht et al., 2017 [28]

Canada

Describe caregivers’ experiences of a child with pediatric AGE and to identify their information needs, preferences, and priorities.

Qualitative; Semi-Structured interviews; Thematic analysis

Qualitative

Child’s symptoms were perceived to not be improving fast enough, worsening symptoms, previous experience with a similar illness requiring emergency care, regular physician (i.e., family doctor or pediatrician) unavailable for consult, recommendation from another health provider (i.e., telephone health advice service, walk-in clinic doctor). Additionally, one caregiver was concerned that the child’s behaviour had changed, and another wanted to use the latest technology in the ED for the best diagnosis, management, and treatment.

Augustine et al., 2016 [29]

USA

Understand the reasons for pediatric return ED visits from the caretaker perspective.

Qualitative;

focus groups; Thematic content analysis

Convenience sample of caretakers recruited by phone or in person at the return visit

Return visits occurred 12 to 50 h (median, 24 h) after the initial visit. Reasons for return visits were divided into 4 domains: (1) the caretaker’s response to the initial visit (e.g., dissatisfaction with medical staff, medical care, or information provided), (2) the child’s illness (e.g., continued, worsening, or concerning symptoms), (3) the nature of the ED itself (e.g., subspecialist availability, convenient hours), and (4) follow-up care (e.g., lack of appointments with primary physicians or subspecialists).

Bartlett et al., 2001 [30]

USA

Examine whether maternal depressive symptoms are associated with ED use.

Quantitative; Survey; Descriptive & Inferential Statistics

Children whose mothers reported that they had (1) asthma diagnosed by a physician, (2) day or night asthma symptoms, including wheezing, shortness of breath, and/or a cough at least once a week during the past 2 weeks, and/or (3) at least 1 visit for asthma to the ED in the previous 6 months or 1 overnight hospitalization for asthma in the previous year.

Mothers who reported the highest tertile of depressive symptoms also reported the most frequent use of the ED (Mantel- Haenszel test, ² = 6.33, P = .01).

Benahmed et al., 2012 [31]

Belgium

Evaluate the rate of pediatric non-urgent use in ED in a subset of 12 Belgian hospitals and to determine the associated factors. The identification of such factors would help the policy marker to design a cost-effective pediatric care system.

Quantitative; Administrative data & questionnaire; Descriptive & multivariate statistics

Children who attended an ED of the 12 hospitals during the 2-weeks period.

Among the 3117 children, attending ED, 39.9% (1244) of visits were considered inappropriate. Five factors were significantly associated with inappropriate use: age of child, distance to ED, having a registered family doctor, out-of-hours visit, and geographic region

Bernthal et al., 2017 [32]

UK

Describe the impact of being a lone parent, particularly when fearful for their partner’s safety and the coping strategies employed by Army parents to combat the challenges presented by Army life.

Qualitative; Focus groups and interviews: observational prospective survey;

Thematic analysis

Parents living or working within the garrison for the subsequent 3-month period

Making sense of the illness, knowing their child, fear for their husband’s safety and the impact of being a lone parent all influenced their decision making when their child was unwell. The mothers in this study found making decisions alone very stressful, particularly when the fear for their partner’s safety made them feel particularly emotionally vulnerable.

Berry et al., 2008 [33]

USA

Identify parents’ reasons for choosing the ED over primary care for non-urgent pediatric care through in-depth parental interviews.

Qualitative; Ethnographic interviews; Thematic analysis

Parents whose children had been to the ED for care during hours when physicians’ offices are routinely open (Monday to Friday, 8 AM to 4 PM) and assigned a nurse triage level of 5 on a 1 to 5 scale (with 5 indicating “no resources likely to be utilized,” or a non- urgent problem).

Parents bring children to the ED for non-urgent care during regular office hours because of PCP referral, better efficiency in the ED, dissatisfaction with PCPs, perceived higher quality of care in the ED, long waits to see PCPs, and PCP communication problems.

Bingham et al., 2015 [34]

Australia

Assess parents’ perspectives on the potential impact of co-payments for general practice and emergency department (ED) services for children.

Quantitative; Survey; Descriptive statistics & logistic regression

Parents of children presenting with lower urgency conditions (triage category 3, 4 or 5) to the EDs of three public general hospitals and one paediatric hospital in Melbourne

73% (n = 1089) of parents reported a $7 general practice co-payment would not increase their use of EDs for lower urgency problems for their children. Increased use was associated with younger parent or guardian age and lower household income.

Buboltz et al., 2015 [35]

Brazil

Understand the strategies of families in search of health care for children attended in pediatric first aid.

Qualitative; Semi-Structured interviews; Content analysis

Family caregivers of children who received care from the health team at the unit, selected based on the children’s medical histories

Caregivers’ used the private health system as a strategy to seek care when the public system was unavailable

Burokienė et al., 2017 [36]

Lithuania

Determine the factors influencing the parental decision to bring their child to the ED for a mi- nor illness that could be managed in a primary healthcare setting

Quantitative; Survey; Descriptive statistics

Purposive

Parents who brought their children to the ED without physician referral were five times more likely to visit the ED during evening hours and on weekends (OR = 5.416; 95% CI, 3.259–8.99; p < 0.001). The decision to come to the ED without visiting a primary care physician was made more often by parents with a higher income (OR = 2.153; 95% CI, 1.167–3.97) and those who came due to children having rash (OR = 4.303; 95% CI, 1.089–16.995) or fever (OR = 3.463; 95% CI, 1.01–11.876). Older parents were 2.07 (95% CI, 1.1224–3.506) times more likely to evaluate their child’s health unfavourably than younger parents.

Cabey et al., 2018 [37]

USA

Explore caretaker decision making processes, values, and priorities when deciding to seek care.

Qualitative; Interviews; Grounded theory

Purposively sampled patients with high or low frequency ED and primary care use for low-acuity visits.

Caretakers who used the ED frequently had limited social support and reported difficulty accessing care when compared to other caretakers. Fear also motivated care seeking and a desire for immediate medical care.

Chin et al., 2006 [38]

USA

Understand patterns of decision making among families presenting to a pediatric emergency department (ED) for non-acute care and to understand pediatric ED staff responses.

Qualitative; in-depth interviews, direct observations, and non-identifying demographic data; thematic

Children registered for care in the shifts under study during the 3-day study period.

Three main themes: [1] most families had been referred by their primary care providers [2]; the complexity of living in low-income areas makes the ED a choice of convenience for these stressed families; and [3] mistrust of primary health services was not identified as a motivator for ED utilization, in contrast with other published data.

Cooper et al., 2003 [39]

Australia

Identify parental reasons for presenting their child to the emergency department and their expectations of the consultation

Quantitative; Cross-sectional survey; Descriptive statistics & odds ratios

Parents of children and adolescents aged ≤14 years who presented to the Fairfield ED over a 2-month period

The majority of presentations were self-referred and chosen because of proximity. Majority of children do not require admission; however, parents often have expectations that observation and further investigation will occur prior to discharge from the emergency department.

Ellbrandt et al., 2018 [40]

Sweden

Evaluate the care-seeking patterns, availability of medical options and initial medical assessments – with overall reference to socioeconomic status – of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare

Quantitative, Questionnaire; Descriptive statistics

Children aged 0–17 years and arriving unscheduled at the paediatric ED during the day (0800 to 1659 h) and evening (1700 to 2059 h) and assessed physician during a peak period of 25 consecutive days in February and March

79% of parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours and were scored as less urgent. A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status.

Fieldston et al., 2012 [41]

USA

Elicit and to describe guardians’ and health professionals’ opinions on reasons for non-urgent pediatric ED visits.

Qualitative;

Focus groups; Thematic analysis

Perceptions of need for medical care or concern about severity of illness, systems issues, such as accessibility and availability of appointments, and some personal or family issues. Many guardians stated a need to receive timely reassurance about their concerns, particularly the more worried they were about the symptoms

Fredrickson et al., 2004 [42]

USA

Clarify the reasons for frequent ER use by Medicaid-insured children with asthma living in rural areas and 23 towns in Kansas as a first step in identifying primary care activities with the potential to reduce such use.

Mixed methods, Administrative data and focus groups; Descriptive Statistics

Medicaid-insured children and children with one or more hospitalizations or at least 3 ER visits for asthma

The decision to use ER services for childhood asthma in the Medicaid-insured population was driven by problems in using primary care services.

Freed et al., 2016 [43]

Australia

Determine why parents seek ED care for their child for lower urgency conditions

Quantitative; Survey;

Statistics

Parents or guardians presenting to the ED with children

43% of parents attempted to make an appointment with a general practitioner (GP) for their child prior to presenting to the ED. Two-thirds of those who did contact a GP were instructed to go to the ED for their lower urgency condition. Few attempted to contact a nurse telephone triage service or after-hours GP service.

Gafforini et al., 2016 [44]

Australia

Assess parental preferences and experiences regarding the treatment of lower urgency child injuries and the role of general practitioners (GPs) in such care

Quantitative; Survey;

Statistics

Parents or guardians presenting to the ED with children

Fewer parents of injured children, compared with illness, attempted to make a GP appointment prior to attending ED (35% vs 46%; P < 0.001). A greater proportion of injured children were referred to the ED by their GP than ill children.

Grant et al., 2010 [45]

USA

Explore reasons for non-urgent pediatric emergency department use in the Mississippi Delta

Quantitative; Interviews

Convenience

Only 24.3% tried to obtain care before emergency department visit; 23.2% said their children required “urgent” care. Mean distance from home to usual source of care was 10 miles. 10% cited transportation as a barrier to keeping health care appointments; 5.5% cited insurance or cost. Families who used the emergency department during evening/weekends were significantly more likely to have cited clinic hours of operation as a reason care was not sought previously than were “business hours” users, who emphasized convenience.

Grigg et al., 2013 [46]

USA

Investigate Latino parents’ decision to seek pediatric emergency care for non-urgent health conditions.

Qualitative; Focus groups; Grounded theory

Purposive

Parents were deeply concerned about the child’s fever, often giving acetaminophen but then seeking medical care when the fever returned. Avoiding double wait times was an important determinant of seeking care in the ED. As patients routinely had long waits to be seen in the clinic, the idea that one might have to “wait twice”—once in clinic and then again at the hospital—made parents more likely to seek ED care directly. Some parents found it particularly hard to obtain same-day clinic appointments for an acute illness. Participants were pleased with the quality of ED care.

Guttman et al., 2003 [25]

USA

Identify reasons for medically non-urgent ED visits from the users’ perspective

Qualitative; Interviews; Thematic approach

parents or guardians who came to the ED for a pediatric visit considered medically non-urgent by the ED triage staff

Caretakers said they came to the ED because it was important to get reassurance that the child’s situation was not serious or would not deteriorate

Harrold et al., 2018 [47]

Canada

Characterize neonatal visits to the emergency department and families to identify potential strategies to decrease neonatal emergency department visits.

Quantitative; Survey; Descriptive Statistics & correlational analysis

Convenience

The majority of respondents (73.9% [1104/1494]) had received advice before going to the emergency department. In most cases (86.4% [954/1104]), this was from a health care provider, who frequently advised going to the emergency department

Hendry et al., 2004 [48]

UK

Gather information on children with minor illness or injury presenting to a paediatric accident and emergency (A&E) department and the decision making process leading to their attendance

Quantitative; Survey; Descriptive statistics

New attenders to the paediatric A&E department during three survey periods

Educational attainment, childcare experience, and parental coping skills were important in relation to A&E attendance. More children attended with injury as opposed to illness. There were no significant demographic differences between those children who presented directly to A&E and those who made prior contact with a GP. Just under half had made contact with a general practitioner (GP) before attending A&E. The majority of those children were directly referred to A&E at that point. GPs referred equivalent numbers of children with illness and injury.

Ingram et al., 2013 [49]

UK

Explore parents’ views on support and information needs prior to consulting when children have RTIs with cough, and identify the triggers and barriers to consulting primary care

Qualitative; Focus groups and interviews; Thematic analysis

Purposive: identified through a search of patient records, in six GP practices, for those who had consulted in the previous 3 months for a child with a respiratory infection

The perception of threat to a child of RTI (with cough) was increased with more severe illness and by perceived susceptibility to illness of a particular child; whilst experience with other children increased parental efficacy to cope with childhood cough at home. Psychological models of health behaviour informed the understanding of cultural beliefs and attitudes that underpin health related behaviours.

Janicke et al., 2003 [50]

USA

Test social-cognitive influences on parent decision making processes related to children’s health care use.

Quantitative; Questionnaires, Statistics

Primary caretakers of children ages 4 to 9 years and their child

The best predictive model, accounting for 29.8% of the variance in primary care use, included the interaction between parental stress and self-efficacy to cope with parenting demands, child behavior problems, self-efficacy for accessing physician assistance, medication use, and parent health care use

Klein et al., 2011 [51]

USA

Determine the distribution and frequency of visits families make to a pediatric primary clinic; and to explore the reasons for families with frequent visits.

Mixed methods; Interviews and survey, Descriptive statistics and thematic analysis

High frequent attenders identified

Overall clinic environment, appointment availability, convenience, insurance/Medicaid, reputation, and friendly office staff.

Kua et al., 2016 [52]

Singapore

Understand the reasons behind non urgent ED visits, in order to develop targeted and effective preventive interventions

Qualitative; Interviews; Grounded theory

Caregivers of children who had been diagnosed with typical non-urgent conditions, namely fever, nosebleed and minor head injury, by the attending physician in the ED

Caregivers heavily influenced by the perceived severity of the disease in the child when deciding on where to go for medical care

Kubicek et al., 2012 [53]

USA

Develop a descriptive profile of parents and caregivers who bring their children to the emergency department for non-urgent issues

Quantitative; Survey; Descriptive statistics & thematic approach

Targeted purposive sampling

The majority of respondents described themselves as Latino (76%) and foreign-born (62%). About half (49%) reported having an annual income of less than $20,000 and 43% of respondents did not have health insurance for themselves. Almost all (95%) of the index children had a primary care physician and health insurance. In spite of being triaged as non-urgent, over half (63%) described their child’s condition as “very” or “extremely” urgent. About half of the respondents reported not receiving basic information on childhood illnesses from their child’s doctor. Reasons for non-urgent visits seemed to revolve around issues of convenience and perception of quality of care.

Lara et al., 2003 [54]

USA

Explore, in a predominantly Latino inner-city population, why caregivers bring their children with asthma to the ED (emergency department).

Quantitative; Survey & medical chart review; Descriptive statistics & thematic approach

Not clear

75% of caregivers cited worsening symptoms as the most important reason for bringing the child to the ED. 25% of parents reported bringing the child to the ED because they could not pay for care or another doctor or another clinic was inconvenient.

Lass et al., 2018 [55]

Denmark

Explore parental contact pattern to OOH services and to explore parents’ experiences with managing their children’s acute health problems.

Qualitative; Interviews; Inductive content analysis

Parents of children under age 4 recruited from a child day care centre in Aarhus, Denmark

Navigation, information, parental worry and parental development appeared to have an impact on OOH services use. The parents found it easy to navigate the health care system, but often used the OOH service instead of their own general practitioner (GP) due to more compatible opening hours and insecurity about the urgency of symptoms.

Long et al., 2018 [26]

USA

Determine which factors influence parents or guardians to choose the ED over their primary care physician (PCP)

Quantitative; Surveys; Descriptive statistics & Thematic approach

Parents or guardians of low-acuity pediatric patients.

Most patients had an established PCP. More than two-thirds did not attempt to contact their PCP prior to their ED visit. Nearly half stated their PCP did not offer after-hours or weekend availability. Most did not feel their child’s condition was serious. Almost half would have waited to see their PCP if they could be seen within 24 h

May et al., 2018 [56]

USA

Explore the decision to seek care and decision- making regarding location of care among parents with low and adequate health literacy.

Qualitative; Semi-structured interviews; Grounded theory

Purposive

Parents with low health literacy were more inclined to overestimate severity of illness and seek care sooner to gain answers about the illness and treatment options and visit the clinic only when an appointment was available within hours. Parents with adequate health literacy sought reassurance for their ongoing illness management and valued close relationships with their physician and were willing to wait longer for an appointment. Fever, vomiting, and young child age prompted some parents to seek expedient care regardless of health literacy.

Morrison et al., 2014 [57]

USA

Examine the association between caregiver health literacy and the likelihood of a non-urgent emergency department (ED) visit in children presenting for fever.

Quantitative; Questionnaire; Statistics

Purposive

Low health literacy was associated with a higher proportion of non-urgent ED visits (44% vs. 31%; OR 1.8; 95% CI 1.1, 2.9). Caregiver black race and public insurance were also related to non-urgent ED use in unadjusted analyses.

Mostajer et al., 2016 [58]

Canada

Explore the reasons that lead parents to select the ED over a dental clinic for their child’s non traumatic dental problem.

Qualitative; Semi-structured interviews; Thematic analysis

Parents of children under age 10 who sought care for non-traumatic dental problems in an ED of a pediatric hospital

Three themes emerged (i) Parental beliefs and socioeconomic challenges contributed to their care seeking, (ii) parents faced barriers in finding oral healthcare options for their children in their communities (e.g., poor access to care and poor quality of care), and (iii) parent’s high satisfaction with the care provided through the ED.

Newcomb et al., 2005 [27]

USA

Account for multiple factors in family decision making, including factors that have been speculative in the literature, but not specifically included together in other studies

Quantitative; Cross-sectional Survey; Descriptive statistics

Purposive

Access to primary care influenced their decision to seek care in the emergency room, as well as workload and quality problems at the primary care level

Nokoff et al., 2014 [59]

USA

Understand and compare caregivers’ perceptions of and attitudes toward care received in a primary care clinic (PCC) versus that received in the pediatric emergency department (PED) as well as the reasons for selecting either location to receive care for their child.

Quantitative; Survey; Descriptive statistics & odds ratios

Parents who brought their child (younger than 18 years) in for a sick visit

Compared with caregivers who brought their child to the PED, those who presented to the PCC were more likely to report that the child had been sick for more than 2 days (P G 0.001), indicate that the child could wait more than 3 h to be seen (P G 0.001), have called the PCC for advice (odds ratio [OR], 5.2; 95% confidence interval [CI], 2.9Y9.2), have spoken with a nurse (OR, 3.7; 95% CI, 2.0Y6.7), be satisfied with their phone call to the PCC (OR, 12.2; 95% CI, 6.4Y23.1), and report that they could easily get in touch with the PCC (OR, 3.6; 95% CI, 1.8Y7.3). Most caregivers who went to the PCC felt that it was more convenient (98.6%) and they would be seen more quickly (95.8%).

Ogilivie et al., 2016 [60]

UK

Understand decision making when bringing a child to an emergency department.

Quantitative; Cross-sectional Survey; Descriptive statistics

Parents attending the emergency department from 10:00 to 22:00, with a child aged 18

Younger parents reported feeling more stressed. Parents of younger children perceived the injury/illness to be more serious, reporting greater levels of worry, stress, helplessness and upset and less confidence.

Pethe et al., 2019

USA

Examine parental reasons associated with the decision to seek ED care in a group of low- income, inner-city, publicly insured children.

Quantitative; Survey; Descriptive statistics

Not clear

There was no difference in those who were aware of walk-in hours or an after-hours phone line and a reported ED visit. Half of the parents (52.5%) thought their child’s medical problem was serious.

Phelps et al., 2000 [61]

USA

Identify specific caretaker and utilization characteristics predictive of the use of the emergency departments (EDs) for non-urgent reasons

Quantitative; Questionnaire- descriptive study; Descriptive statistics

Caretakers who brought their children to 1 of 2 urban hospital EDs

Caretakers who reported being taken to the ED when they were children and those with Medicaid insurance were more likely to view the ED as the usual site of care. Being a single parent was a predictor for non-urgent visits

Philips et al., 2012 [62]

The Netherlands

Reveal the crucial decision criteria of patients in choosing out-of-hours services

Quantitative; Discrete Choice Experiment;

Multinomial Logit Model

All consumers at the Free Newborn and Child health care service (FNC service) in Antwerp.

Patients considered the ‘explanation’ about the problem and the treatment as the most important factor in the choice of service (‘child’: 38.5%), followed by the waiting time for consultation (‘waiting time’: ‘child’: 23.8%).

Philips et al., 2010 [63]

The Netherlands

Identify consumers’ preferences for after-hours medical care and predict the use of the new GPDS.

Quantitative; Questionnaire, Statistics

All consumers at the Free Newborn and Child health care service (FNC service) in Antwerp.

Main reasons for choosing ED are “sufficient explanation” and “easy access”. Consumers also expect immediate technical examination at the ED and when visiting a paediatrician. Compared to the ED and the paediatrician, “waiting time” was the most appreciated attribute at the GPDS.

Salami et al., 2012 [64]

USA

Determine the most important reasons for pediatric non-urgent (NU) emergency department (ED) visits as perceived by caregivers,

Quantitative; Survey; Descriptive statistics

Convenience sample of low acuity visits (triage categories 4 and 5).

The reasons most important to the caregivers were “outside PCP working hours,” “lack of health insurance,” and “better hospitality in ED”

Scott et al., 2003 [65]

UK

Elicit the preferences of patients and the community for different models of GP out of hours care.

Quantitative; DCE;

Random effects model

Parents of children in Aberdeen and Glasgow who had received a home visit or attended a primary care emergency centre, or were registered with a GP

The most important attribute was whether the doctor seemed to listen, suggesting that policies aimed at improving doctor–patient communication will lead to the largest improvements in utility. The most preferred location of care was a hospital accident and emergency department.

Sharma et al., 2014

Australia

Explore the reasons prompting Australian parents to seek medical advice for their sick children, and to define the factors influencing their decision.

Qualitative; Semi-Structured interviews; Thematic Analysis

Not clear

Five emergent themes were fears about possible scenarios; personal and vicarious experiences; resources and convenience; being seen to do the right thing; and reassurance and guidance about management.

Siminski et al., 2008 [66]

Australia

Quantitative; Survey; Descriptive statistics

Convenience

Problem too urgent, problem too serious, better service at ED

Smith et al., 2015 [67]

Canada

Explore the factors associated with parents’ decisions to bring their children to the pediatric emergency department (PED) for non-emergent concerns.

Quantitative; Cross- sectional survey; Descriptive statistics

participants who had contacted any health care provider (primary care physician [PCP], walk-in clinic, BC Nurse Line, another ED, or other) in the 48 h prior to coming to the PED

The top 3 reasons for coming to the British Columbia Children’s Hospital PED were (1) that it specializes in children, (2) child has medical issues previously managed at the same hospital, and (3) closest location to patient.

Stanley et al., 2007 [68]

USA

Explore parental rationale and the appropriateness of children’s visits to emergency departments (EDs) for non-urgent complaints.

Quantitative; Semi-structured interviews/ survey; Descriptive statistics

Parents/guardians of children aged 6 months to 18 years who presented to the ED with non-urgent complaints

The most common parent-reported reason for going to the ED was reassurance (41%), followed by thinking the situation was an emergency (33%).

Stingone et al., 2005 [69]

USA

Evaluate the role of socioeconomic, disease-related, and access-to-care factors in utilization of the ED and inpatient services for urgent treatment of asthma.

Quantitative; Cross - sectional questionnaire; Descriptive statistics

Schools were randomly selected based on the childhood asthma hospitalization rate in each neighbourhood.

In univariate analysis, use of urgent care was strongly associated with race/ethnicity and income

Stockwell et al., 2011 [70]

USA

Understand the utilization of the pediatric emergency department (PED) of an academic hospital during regular primary care office hours during the 2009 H1N1 epidemic.

Quantitative; cross- sectional survey/ secondary analysis; Descriptive statistics

Parents visiting a PED in a low-income area in New York City

No sociodemographic differences among children brought to the PED for ILI and those brought for other presenting symptoms

Stoddart et al., 2006 [71]

Australia

Design a qualitative pilot study aiming to explore this issue using semi-structured interviews

Qualitative; Semi-structured interviews; Iterative thematic approach

Parents attending GP

Parents sought an examination of their child (in particular “hidden areas” such as ears and throat) and reassurance, rather than antibiotics. They also wanted the GP to suggest practical ways to help alleviate their child’s symptoms.

Turbitt et al., 2016 [72]

Australia

Study the prevalence of a regular source of primary care for Victorian children attending one of four emergency departments (EDs) and to determine associated characteristics, including ED use.

Quantitative; Survey; Descriptive statistics

Parents or guardians of patients (≤9 years of age) attending the ED at one of four Victorian hospitals

No associations were observed between having a regular source of primary care and frequency of ED attendance in the past 12 months, although parents whose child did not have a regular source of primary care were more likely to view the ED as a more convenient place to receive care than the primary care provider

Vaughn et al., 2012 [73]

USA

Assess Latino immigrant usage, access, and reason for coming to the pediatric emergency department (PED) and clarify parental perceptions, barriers, and concerns regarding Latino children’s health.

Quantitative; Interviews & Survey; Descriptive statistics

Convenience

Latinos with lower levels of acculturation were more likely to use the PED to meet their children’s health care needs.

Williams et al., 2009 [74]

Australia

The primary aim of this study was to provide a

comprehensive, systematic understanding of the motivations and actions of parents of children with

non-urgent illnesses who attend a PED

Quantitative; Survey; Descriptive statistics

Parents of children who attended the PED with a non- urgent condition

The factors identified were: parents rated their child’s condition as moderate to very serious (242 (68%)); two-thirds of parents (234 (66%)) had sought advice prior to attending the emergency department; 54% [68] of the 137 children who attended with an injury presented promptly to emergency (i.e., within 4 h of injury) whereas of the 216 presenting with an illness, 41% [80] presented within 2–7 days of the onset of the illness.

Woolfenden et al., 2000 [75]

Australia

Explore the parental attitudes, perceptions and beliefs that play a role in the use of a tertiary paediatric emergency department (PED) when a child has a non-urgent illness.

Qualitative; Interviews; Thematic analysis

Parents of children with non-urgent illnesses recruited in the waiting room of a tertiary PED

Parents used their own system of triage to choose the appropriate service for their sick child. The perceived expertise of the tertiary PED, access and parental expectations all appeared to be major factors in parental use of a PED.

Zandieh et al., 2009 [76]

USA

Determine important predictors of why parents seek care for their children at a pediatric emergency department (ED) compared to their child’s primary care provider’s (PCP’s) walk-in clinic.

Quantitative; Cross-sectional survey;

Statistics

Convenience

87 (51%) were seeking care at the ED and 83 (49%) at their child’s walk-in clinic. In logistic regression, single parenting was the strongest predictor for seeking care in the

ED (OR, 5.54; 95% confidence interval [CI], 1.4Y26.9), followed by Hispanic ethnicity (OR, 4.96; 95% CI, 1.43–17.2), low parental perceptions of their child’s physical health (OR, 0 .90; 95% CI, 0.82Y0.99), controlling for number of chronic conditions, parental working status, and satisfaction with their PCP.

Zickafoose et al., 2015 [77]

USA

Assess parents’ relative preferences for different categories of enhanced access services in primary care.

Quantitative; DCE;

Mixed logic model

Participants were sampled from a nationally representative online panel of individuals maintained by Knowledge Networks, a survey research firm

Parents were most likely to choose primary care offices that guaranteed same-day sick visits (coefficient, 0.57 followed by those with higher professional continuity (coefficient, 0.36 [SE, 0.03]; P < .001). Parents were also significantly more likely to choose practices with 24-h telephone advice plus non-urgent email advice (0.08 [0.04]; P < .05), evening hours 4 or more times a week (0.14 [0.04]; P < .001), and at least some hours on weekends. Parents were significantly less likely to choose practices that were closed during some weekday daytime hours or had wait times longer than 4 weeks for preventive care visits. There was very little variation in preferences among parents with different sociodemographic characteristics. Parents’ marginal willingness to travel was 14 min (95% CI, 11–16 min) for guaranteed same-day sick visits and 44 min (95% CI, 37–51 min) for an office with idealized levels of all services.

Zickafoose et al., 2013 [78]

USA

Explore (1) parents’ preferences for enhanced access services in a pediatric primary care medical home and (2) parents’ willingness to make trade-offs between enhanced access services and other aspects of primary care.

Qualitative; Semi-structured interviews; Thematic analysis

Purposive

Parents had strong preferences for certain services, such as same-day sick care appointments, and were willing to make trade-offs for high-priority services.