0
Editorial |

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

Stephen Berman, MD
Arch Pediatr Adolesc Med. 2008;162(2):186-188. doi:10.1001/archpediatrics.2007.19.
Text Size: A A A
Published online

Extract

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

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
The diagnosis and management of acute otitis media. Pediatrics 2013;131(3):e964-99.
Complementary and alternative medicine for pediatric otitis media. Int J Pediatr Otorhinolaryngol 2013;77(6):926-31.
Jobs
JAMAevidence.com

The Rational Clinical Examination
Make the Diagnosis: Otitis Media, Child

The Rational Clinical Examination
Original Article: Does This Child Have Acute Otitis Media?

brightcove.createExperiences();