Document Detail

Practice variations among pediatricians and family physicians in the management of otitis media.
MedLine Citation:
PMID:  7633535     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine theoretical practice patterns and Medicaid practices in the management of persistent and recurrent otitis media by family physicians and pediatricians in Colorado. METHODS: Members of the Colorado chapters of the American Academy of Pediatrics and the Colorado Academy of Family Medicine were surveyed with the use of two hypothetical case management scenarios for which they were asked to indicate which International Classification of Diseases, Ninth Revision, Medicaid codes they would use. Physicians were presented with two case scenarios (one involving a persistent asymptomatic middle ear effusion and the second involving recurrent otitis media) and were asked to choose from a variety of management options, including observation, antibiotic therapy, decongestants, corticosteroids, antibiotic prophylaxis, and referral for ventilation tube surgery. RESULTS: Family physicians would have prescribed high-cost antibiotics (amoxicillin plus clavulanate potassium, cefaclor, or cefixime) to treat persistent middle ear effusions twice as often as pediatricians would have (P < .002). At the 6-week visit, 50 family physicians (43%) would administer an oral decongestant either alone or in combination with other therapy as compared with 16 (14%) of pediatricians (P < .001). Family physicians would refer patients for ventilating tube surgery three times more often than pediatricians at the 9-week visits (P < .001). Recurrent episodes of acute otitis media would be managed similarly by both physician groups. Respondents reported a wide variety of International Classification of Diseases, Ninth Revision, coding, often coding persistent effusions as acute otitis or as unspecified otitis media. CONCLUSIONS: The findings of this survey document the wide variation in practice patterns for treating children with persistent otitis media and children with recurrent otitis media in Colorado.
R Roark; J Petrofski; E Berson; S Berman
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Publication Detail:
Type:  Case Reports; Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Archives of pediatrics & adolescent medicine     Volume:  149     ISSN:  1072-4710     ISO Abbreviation:  Arch Pediatr Adolesc Med     Publication Date:  1995 Aug 
Date Detail:
Created Date:  1995-09-14     Completed Date:  1995-09-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9422751     Medline TA:  Arch Pediatr Adolesc Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  839-44     Citation Subset:  AIM; IM    
Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
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MeSH Terms
Child, Preschool
Decision Making
Family Practice / organization & administration*
Middle Ear Ventilation
Otitis Media with Effusion / diagnosis*,  drug therapy*,  therapy
Pediatrics / organization & administration*
Physician's Practice Patterns*
Sulfamethoxazole / therapeutic use*
Trimethoprim / therapeutic use*
Reg. No./Substance:
723-46-6/Sulfamethoxazole; 738-70-5/Trimethoprim

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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