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    Watchful waiting for acute otitis media: are parents and physicians ready

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    Authors
    Finkelstein, Jonathan A.
    Stille, Christopher J.
    Rifas-Shiman, Sheryl L.
    Goldman, Donald
    UMass Chan Affiliations
    Department of Pediatrics
    Document Type
    Journal Article
    Publication Date
    2005-06-03
    Keywords
    Acute Disease
    Adult
    Anti-Bacterial Agents
    Attitude of Health Personnel
    Attitude to Health
    *Case Management
    Child
    Child, Preschool
    Culture
    Data Collection
    Decision Making
    Drug Resistance
    Family Practice
    Humans
    Infant
    Massachusetts
    Mothers
    Otitis Media
    Parents
    Patient Acceptance of Health Care
    Patient Education as Topic
    Pediatrics
    Personal Satisfaction
    Physician's Practice Patterns
    Physicians
    Sampling Studies
    Pediatrics
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    Link to Full Text
    http://dx.doi.org/10.1542/peds.2004-1473
    Abstract
    OBJECTIVE: To assess the current use of initial observation ("watchful waiting") of acute otitis media among community physicians and the acceptability of this option to parents of young children. SETTING: Sixteen nonoverlapping Massachusetts communities enrolled in a community intervention study on appropriate antibiotic use. DESIGN: Pediatricians, family physicians, and a random sample of parents of children less than 6 years old were surveyed. Parents predicted what their satisfaction would be with initial observation of an ear infection without antibiotics if suggested by their physician and concerns they would have regarding this watchful-waiting approach. Physicians reported the frequency with which they use this approach in children less than or = 2 years and those less than 2 years old. Separate multivariable models identified factors independently associated with parental satisfaction and with frequency of self-reported use by physicians. All models accounted for clustering of responses within communities. RESULTS: Two thousand fifty-four (40%) parents and 160 (58%) physicians responded. Of the parents, 34% would be somewhat or extremely satisfied if initial observation was recommended, another 26% would be neutral, and the remaining 40% would be somewhat or extremely dissatisfied. The multivariable model showed lower parental education (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.35, 0.71, for high school education or less compared with college graduation) and Medicaid enrollment (OR: 0.77; CI: 0.57, 1.0) was associated with lower predicted satisfaction. Higher antibiotic-related knowledge (OR: 1.2; CI: 1.1, 1.3, per question correct), belief that antibiotic resistance is a serious problem (OR: 2.3; CI: 1.8, 2.8), and reporting feeling included in medical decisions (OR: 1.4; CI: 1.1, 1.7) all were independently associated with higher predicted satisfaction. Thirty-eight percent of physicians treating children greater than or = 2 years old never or almost never reported using initial observation, 39% reported use occasionally, 17% sometimes, and 6% most of the time. In a multivariable model, only more years in practice (OR: 0.96; CI: 0.93, 0.99) was associated with a decreased likelihood of occasional or more-frequent use of watchful waiting (compared with those who never use initial observation). However, a secondary model that combined occasional users with nonusers (compared with those reporting use sometimes or more often) identified several correlates of use of observation: years in practice (OR: 0.95; CI: 0.91, 0.99), family medicine specialization (OR: 4.5; CI: 1.9, 11), belief that antibiotic resistance is a significant problem (OR: 4.3; CI: 1.3, 14.5), and practice in a community receiving a judicious antibiotic-use intervention (OR: 3.5; CI: 1.3, 9.1). CONCLUSIONS: A majority of physicians reported at least occasionally using initial observation, but few use it frequently. Many parents have concerns regarding this option, but acceptability is increased among those with more education and those who feel included in medical decisions. Substantial change in both parental and provider views would be needed to make initial observation a widely used alternative for acute otitis media.
    Source
    Pediatrics. 2005 Jun;115(6):1466-73. Link to article on publisher's site
    DOI
    10.1542/peds.2004-1473
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/43261
    PubMed ID
    15930205
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1542/peds.2004-1473
    Scopus Count
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