title: Referral of children with otitis media. Do family physicians and pediatricians agree?
abstract: OBJECTIVE
  To determine factors influencing family physicians' and pediatricians' decisions to refer children with recurrent acute otitis media (RAOM) and otitis media with effusion (OME) to otolaryngologists for an opinion about tympanostomy tube insertion.
  
  
  METHODS
  Mailed survey.
  
  
  METHODS
  Physicians' practices in Ontario.
  
  
  METHODS
  Random sample of 1459 family physicians and all 775 pediatricians in the province.
  
  
  METHODS
  Physicians' reports of the influence of 17 factors on decisions to refer (more likely, no influence, less likely to refer) and number of episodes of otitis media, months with effusion, level of hearing loss, or months of continuous antibiotics without improvement prompting referral.
  
  
  RESULTS
  Physicians agreed (> 80% concordance) on six out of 17 factors as indications for referring children with RAOM or OME. Opinions about the importance of other factors varied widely. Family physicians would refer children with otitis media after fewer episodes of illness, fewer months of effusion, lower levels of hearing loss, and fewer months of prophylactic antibiotic therapy than pediatricians (all P < .001). Pediatricians would prescribe continuous antibiotics longer (11.8 weeks) than family physicians (8.9 weeks, P < .0001), which correlated with lower referral thresholds for family physicians.
  
  
  CONCLUSIONS
  Family physicians' and pediatricians' self-reported referral practices for surgical opinions on children with otitis media varied considerably. These observations raise questions about the consistency of care for children with otitis media and whether revised clinical guidelines would be helpful.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Ontario. wmcisaac@mtsinai.on.ca
authors.forename: W J
authors.initials: WJ
authors.lastname: McIsaac
authors.forename: P
authors.initials: P
authors.lastname: Coyte
authors.forename: R
authors.initials: R
authors.lastname: Croxford
authors.forename: S
authors.initials: S
authors.lastname: Harji
authors.forename: W
authors.initials: W
authors.lastname: Feldman
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005194:Family Practice / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D009864:Ontario; D010033:Otitis Media / Q000628:therapy*; D010034:Otitis Media with Effusion / Q000628:therapy*; D010036:Otolaryngology; D018579:Patient Selection; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012008:Recurrence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors