Feedback with Education versus Digital Otoscopy for Acute Otitis Media Diagnosis and Treatment.
Jonathan Hatoun, Laura Burckett Patane, Jane Bittner Gould et al.
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In 30 seconds
This randomized controlled trial evaluated whether feedback with education, digital otoscopy, or both could reduce acute otitis media (AOM) treatment among 40 primary care pediatricians whose treatment rates exceeded the network mean. Compared with control, feedback with education was associated with a 12.8 percentage-point reduction in treatment rate from baseline (95% CI: -20.9 to 4.7), and the combined intervention with a 9.7 percentage-point reduction (95% CI: -16.5 to 2.9). Digital otoscopy alone did not significantly change the outcome. Clinicians reported better tympanic membrane visualization with digital otoscopy, and 70% preferred it to a traditional otoscope.
Key findings
- Feedback with education reduced AOM treatment rate relative to control by -12.8% (95% CI: -20.9 to 4.7).
- The combined feedback/education and digital otoscopy arm showed a relative change of -9.7% (95% CI: -16.5 to 2.9).
- Digital otoscopy alone did not significantly change treatment rate (-7.3% [95% CI: -16.8 to 2.3]).
- Among clinicians using digital otoscopy, 70% preferred it over a traditional otoscope.
Why it matters
The findings suggest that clinician feedback and education may help reduce antibiotic treatment for AOM in practices with above-average treatment rates. Digital otoscopy improved reported visualization and was preferred by many users, but did not independently produce a significant treatment-rate change in this trial. These results distinguish a potentially useful stewardship strategy from a technology whose clinical impact remains uncertain.
What to keep in mind
The trial included 40 pediatricians selected for treatment rates above the network mean, which may limit applicability to other clinicians or settings.