Feedback with Education versus Digital Ototscopy for Acute Otitis Media Diagnosis and Treatment.

Abstract

To determine if feedback with education and digital otoscopy could each potentially address lack of knowledge of acute otitis media (AOM) diagnostic criteria and difficulty visualizing the tympanic membrane and then result in more judicious use of antibiotics for AOM. Randomized controlled trial of 40 primary care pediatricians who each had an AOM treatment rate, defined as the proportion of encounters with an AOM diagnosis and antibiotic treatment divided by all encounters with a respiratory condition, above the network mean. Subjects were randomized into 1 of 4 arms: feedback with education, digital otoscopy, both, or control. A difference-in-differences analysis was used to assess for change in the intervention arms relative to the control arm. Both the feedback/education and combined arms of the study demonstrated a significant change in the AOM treatment rate relative to baseline compared with the control arm (-12.8% [95% CI: -20.9, -4.7] and -9.7% [-16.5, -2.9], respectively), yet digital otoscopy alone did not yield a significant change in the outcome (-7.3% [-16.8, 2.3]). Clinicians using digital otoscopy reported improved visualization of tympanic membranes and 70% would prefer a digital otoscope to a traditional otoscope. Antibiotic use for AOM can be modified with performance feedback and education. Although there appears to be no added effect of digital otoscopy alone in this trial, clinicians using digital otoscopy preferred it to traditional otoscopy and this technology holds promise for further development in AOM-related antibiotic stewardship.