Referral of children with otitis media - Do family physicians and pediatricians agree?

OBJECTIVE To determine factors influencing family physicians' and pediatric ians' decisions to refer children with recurrent acute otitis media (RAOM) and otitis media with effusion (OME) to otolaryngologists for an opinion ab out tympanostomy tube insertion. DESIGN Mailed survey. SETTING Physicians' practices in Ontario. PARTICIPANTS Random sample of 1459 family physicians and all 775 pediatrici ans in the province. MAIN OUTCOME MEASURES Physicians' reports of the influence of 17 factors on decisions to refer (more likely, no influence, less likely to refer) and n umber of episodes of otitis media, months with effusion, level of hearing l oss, or months of continuous antibiotics without improvement prompting refe rral. RESULTS Physicians agreed (>80% concordance) on six out of 17 factors as in dications for referring children with RAOM or OME. Opinions about the impor tance of other factors varied widely. Family physicians would refer childre n with otitis media after fewer episodes of illness, fewer months of effusi on, lower levels of hearing loss, and fewer months of prophylactic antibiot ic therapy than pediatricians (all P < .001). Pediatricians would prescribe continuous antibiotics longer (11.8 weeks) than family physicians (8.9 wee ks, P < .0001), which correlated with lower referral thresholds for family physicians. CONCLUSION Family physicians' and pediatricians' self-reported referral pra ctices for surgical opinions on children with otitis media varied considera bly. These observations raise questions about the consistency of care for c hildren with otitis media and whether revised clinical guidelines would be helpful.