PRACTICE VARIATIONS AMONG PEDIATRICIANS AND FAMILY PHYSICIANS IN THE MANAGEMENT OF OTITIS-MEDIA

Objectives: To determine theoretical practice patterns and Medicaid pr actices in the management of persistent and recurrent otitis media by family physicians and pediatricians in Colorado. Methods: Members of t he Colorado chapters of the American Academy of Pediatrics and the Col orado Academy of Family Medicine were surveyed with the use of two hyp othetical case management scenarios for which they were asked to indic ate which International Classification of Diseases, Ninth Revision, Me dicaid codes they would use. Physicians were presented with two case s cenarios (one involving a persistent asymptomatic middle ear effusion and the second involving recurrent otitis media) and were asked to cho ose from a variety of management options, including observation, antib iotic therapy, decongestants, corticosteroids, antibiotic prophylaxis, and referral for ventilation tube surgery. Results: Family physicians would have prescribed high-cost antibiotics (amoxicillin plus clavula nate 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 deco ngestant either alone or in combination with other therapy as compared with 16 (14%) of pediatricians (P<.001). Family physicians would refe r patients for ventilating tube surgery three times more often than pe diatricians at the 9-week visits (P<.001). Recurrent episodes of acute otitis media would be managed similarly by both physician groups. Res pondents reported a wide variety of International Classification of Di seases, Ninth Revision, coding, often coding persistent effusions as a cute otitis or as unspecified otitis media. Conclusions: The findings of this survey document the wide variation in practice patterns for tr eating children with persistent otitis media and children with recurre nt otitis media in Colorado.