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February 2008

Otitis Media, Shared Decision Making, and Enhancing Value in Pediatric Practice

Arch Pediatr Adolesc Med. 2008;162(2):186-188. doi:10.1001/archpediatrics.2007.19

How can we improve performance in pediatric practice? How can we identify situations in which we can enhance quality while reducing costs to maximize the value of our services? How can we best refocus care processes to be more efficient and patient centered? The answers to these questions will be critical to the redesign of 21st-century pediatric practice. However, the answers are likely to emerge from a series of small steps that together form a larger roadmap. These small steps will have a common theme: ways of better educating and empowering parents through shared decision making. Just as the pharmaceutical companies have shifted much of their attention to direct consumer marketing from physician marketing, we must rebalance our approach and shift more of our attention from physician guidelines to parent education and shared decision making. Targeting ear pain and acute otitis media (AOM) for this shift in emphasis seems reasonable because this condition is such a frequent cause of pediatric visits during early childhood and so often results in an antibiotic prescription. We can enhance quality by reducing excessive antibiotic use that contributes to rising rates of bacterial antibiotic resistance in the community. More judicious antibiotic use may also reduce the frequency of AOM episodes as studies suggest that antibiotic treatment alters nasopharyngeal colonization that predisposes to an earlier subsequent episode.1,2 We can also reduce costs by avoiding unnecessary visits for ear pain and otitis to primary care offices during normal hours and to emergency departments and urgent care centers after hours. These visits are very common and are the largest component of well over $5 billion spent annually on otitis media.3 Children between the ages of 1 and 3 years account for more than 40% of otitis-related expenditures in children younger than 14 years.3