Early return visits by pediatric primary care patients with otitis media: a retail nurse practitioner clinic versus standard medical office care.

PURPOSE: To compare outpatient return visits within 2 weeks experienced by pediatric patients diagnosed with otitis media using retail nurse practitioner clinics to similar patients using standard medical office clinics. BACKGROUND: The impact of retail clinics on return visit rates has not been extensively studied. DATA SOURCE: Electronic medical records of pediatric primary care patients seen in a large group practice in Minnesota in 2009 for otitis media. SAMPLE: Patients seen in retail walk-in clinics staffed by nurse practitioners (N = 627) or regular office clinics (N = 2353). OUTCOME MEASURE: A return visit to any site within 2 weeks. RESULTS: The percentage returning was higher in standard care patients than in retail medicine patients (21.0 vs 11.2, P < .001). The odds of a return visit within 2 weeks were higher in standard care patients than in retail medicine patients after adjusting for propensity to use services, age, and gender (odds ratio = 1.54, P < 0.01). CONCLUSION: In this group practice, the odds of return visits within 2 weeks for pediatric patients treated for otitis media were lower in retail medicine clinics than in standard office clinics.

A program of anticipatory guidance for the prevention of emergency department visits for ear pain.

OBJECTIVE: To test whether well-child care visit anticipatory guidance can safely reduce emergency department (ED) visits. DESIGN: Retrospective analysis comparing an intervention site with control sites using a "difference-in-differences" regression model. SETTING: Primary care practices at the Mayo Clinic. PARTICIPANTS: Children who attended a 15-month well-child care visit. INTERVENTIONS: Nurses provided standardized education and prescribed antipyrine-benzocaine otic drops at the 15-month well-child care visit. Education focused on controlling otalgia, recognizing signs of more serious illness, and decreasing the sense of medical urgency for uncomplicated ear pain. MAIN OUTCOME MEASURES: Visit rates for ear pain during the ensuing year were compared in 4 retrospective cohorts: the intervention cohort (n = 191), a cohort from the same practice the preceding year (n = 168), and as controls, cohorts from these same years at other primary care sites not adopting this intervention (n = 133 and 126). RESULTS: After the intervention, ED visits for ear pain decreased 80%; urgent care visits, 40%; and primary care visits, 28%, with no significant change in the control sites' visit use during this time. Regression models incorporating patient characteristics and comparing the changes between sites across time supported the belief that the decline in ED use was significant (P = .009), with no significant change in urgent care (P = .33) or primary care (P = .14) use. On questionnaires, more than 80% of parents whose children had experienced subsequent ear pain responded that the program helped them avoid an ED or after-hours visit and strongly recommended continuing the education program. CONCLUSION: Nurse-administered anticipatory guidance reduced ED visits for ear pain in toddlers and was well appreciated by parents.

Tympanometry by nurses--can allocation of tasks be optimised?

OBJECTIVE: Acute otitis media and secretory otitis media are the most common pediatric infectious disease with a substantial impact on especially primary health care. If nurses could perform and interpret tympanometries, family practitioners workload could be reduced. We wanted to investigate the ability of nurses to perform tympanometry and evaluate the amount of training required. METHODS: Prospective study comparing results from tympanometry with results at myringotomy at a University Central Hospital was conducted. Nurses at the Paediatric Ear, Nose, and Throat Department performed tympanometry prior to myringotomy. Sensitivity and specificity of tympanometries versus myringotomy were calculated. Nurses' opinions about tympanometry and training required were evaluated. RESULTS: During a 1-year period, 199 children were enrolled in the study and 392 tympanograms were analyzed. Sensitivity of tympanograms to detect middle-ear fluid was 0.54, and specificity 0.82. Secretion occurred in 22.5% of children with type A curves and 45.3% of those with type C curves. Nurses evaluated their training in tympanometry as adequate. CONSCLUSIONS: A single training session in tympanometry is inadequate to qualify nurses to perform tympanometry independently. Thorough research and testing to evaluate the quality of such training is required to produce reliable tympanograms.

Survey of parenting books for advice on the common cold, diarrhea, and otitis media in infants and toddlers.

Parenting books often provide advice for common medical ailments of infants and toddlers. However, the accuracy of such advice has never been evaluated. The purpose of this study is to survey the informational content of a sample of parenting books. Fifty general parenting books were identified and reviewed for the informational content on the following topics: common colds, diarrhea, and otitis media. When covered by the book, accurate and consistent information was generally provided in the following topic areas: non-medicated nose drops for nasal congestion, upright positioning for children with colds, breastfeeding infants with diarrhea, electrolyte solutions for diarrhea, and feeding practices as they relate to otitis media. The following topic areas displayed significant inconsistency: the use of decongestants, antihistamines, expectorants, cough suppressants, and decongestant nose drops for colds; antidiarrheal medications; soft drinks and juice for diarrhea; home recipes for oral hydration solutions; and the usefulness of pressure equalization tubes for refractory otitis media. Practitioners should be aware that parents may be misinformed by some parenting books and take measures to educate parents.

The judicious use of antibiotic agents in common childhood respiratory illness.

Increased bacterial resistance is caused most frequently by the widespread use of antimicrobial agents. Antimicrobial agents are often used inappropriately to treat common respiratory illnesses in children. This article discusses the judicious use of antimicrobials in the common cold, otitis media, acute sinusitis, pharyngitis, and bronchitis.

Acute otitis media in an era of drug resistance: implications for NP practice.

Nearly two-thirds of all children will have at least one episode of acute otitis media (AOM) by age 2 years. Acute otitis media is the most common indication for pediatric outpatient and antibiotic therapy. Minimizing AOM risk factors, prescribing the most appropriate and effective AOM therapy while limiting inappropriate antimicrobial use is an important part of the pediatric primary care.

Diagnosis and pharmacological management of acute otitis media.

Acute otitis media (AOM) is one of the most commonly diagnosed problems by primary care providers. Diagnosis of AOM is based upon positive physical findings of a full or bulging tympanic membrane (TM), absent or obscured bony landmarks, distorted or absent light reflex, and decreased or absent mobility of the TM. Prevention through education and early detection of AOM are the best methods for avoiding serious complications and sequelae. The antibiotics available for treatment of AOM are extensive. Treatment of AOM should be based upon clinical diagnosis and current research-based options for treatment.

Otitis media in the pediatric patient.

Otitis media is the most common reason for infants and children to seek medical care except for well child examinations. This paper discusses the etiology of the illness, pathophysiology, physical assessment techniques, current treatment guidelines, and nursing care issues. The differences between children and adults when caring for these patients will be emphasized.

Measuring outcomes in nursing centers: otitis media as a sample case.

While it is generally recognized that NPs offer affordable, quality health care, few studies have measured outcomes of clients who seek primary care services from NPs. This pilot study describes the outcomes of children with otitis media who received care from NPs employed in an academic nursing center. Outcome measurements included issues related to timing, level of analysis, and attribution. Parents of 27 children participated in a telephone survey consisting of seven questions relating to the care their children received from NPs and their recovery path. Although every respondent reported having a positive visit at the nursing center, concerns for NPs surfaced during the process of measuring outcomes. This study emphasizes the need for measuring outcomes in nursing clinics and demonstrates one way to measures client outcomes, revealing both general health care and specific nursing practice implications.