Roark R, Petrofski J, Berson E, Berman S
Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
Arch Pediatr Adolesc Med. 1995 Aug;149(8):839-44. doi: 10.1001/archpedi.1995.02170210013002.
To determine theoretical practice patterns and Medicaid practices in the management of persistent and recurrent otitis media by family physicians and pediatricians in Colorado.
Members of the Colorado chapters of the American Academy of Pediatrics and the Colorado Academy of Family Medicine were surveyed with the use of two hypothetical case management scenarios for which they were asked to indicate which International Classification of Diseases, Ninth Revision, Medicaid codes they would use. Physicians were presented with two case scenarios (one involving a persistent asymptomatic middle ear effusion and the second involving recurrent otitis media) and were asked to choose from a variety of management options, including observation, antibiotic therapy, decongestants, corticosteroids, antibiotic prophylaxis, and referral for ventilation tube surgery.
Family physicians would have prescribed high-cost antibiotics (amoxicillin plus clavulanate 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 decongestant either alone or in combination with other therapy as compared with 16 (14%) of pediatricians (P < .001). Family physicians would refer patients for ventilating tube surgery three times more often than pediatricians at the 9-week visits (P < .001). Recurrent episodes of acute otitis media would be managed similarly by both physician groups. Respondents reported a wide variety of International Classification of Diseases, Ninth Revision, coding, often coding persistent effusions as acute otitis or as unspecified otitis media.
The findings of this survey document the wide variation in practice patterns for treating children with persistent otitis media and children with recurrent otitis media in Colorado.
确定科罗拉多州的家庭医生和儿科医生在持续性和复发性中耳炎管理方面的理论实践模式及医疗补助实践情况。
采用两种假设的病例管理场景对美国儿科学会科罗拉多分会和科罗拉多家庭医学学会的成员进行调查，要求他们指出会使用的《疾病和有关健康问题的国际统计分类》第九版医疗补助编码。向医生展示两个病例场景（一个涉及持续性无症状中耳积液，另一个涉及复发性中耳炎），并要求他们从多种管理选项中进行选择，包括观察、抗生素治疗、减充血剂、皮质类固醇、抗生素预防以及转诊进行通气管手术。
在治疗持续性中耳积液时，家庭医生开具高成本抗生素（阿莫西林加克拉维酸钾、头孢克洛或头孢克肟）的频率是儿科医生的两倍（P < .002）。在6周复诊时，50名家庭医生（43%）会单独或与其他治疗联合使用口服减充血剂，而儿科医生中这一比例为16名（14%）（P < .001）。在9周复诊时，家庭医生将患者转诊进行通气管手术的频率是儿科医生的三倍（P < .001）。两个医生群体对急性中耳炎复发发作的处理方式相似。受访者报告了各种各样的《疾病和有关健康问题的国际统计分类》第九版编码，经常将持续性积液编码为急性中耳炎或未明确的中耳炎。
本次调查结果表明，科罗拉多州在治疗持续性中耳炎儿童和复发性中耳炎儿童的实践模式方面存在很大差异。
