A recent study has investigated the implementation of shared decision-making in emergency departments for managing acute otitis media (AOM) among children. The study focused on a web-based tool, the Ear Pain Decision Aid (EPDA), aimed at enhancing parental knowledge and engagement while addressing concerns related to antibiotic prescriptions.
Acute otitis media is a prevalent condition resulting in antibiotic prescriptions for children, often leading to conflicts between parental expectations and clinical guidelines. Many parents enter emergency departments, expecting immediate antibiotic treatment, despite guidelines suggesting a trial of analgesics for 48 to 72 hours before initiating antibiotics.
In light of the high rates of antibiotic prescribing in emergency departments, the study aimed to measure the impact of the EPDA tool on parent knowledge, clinician/parent engagement, interaction time, and antibiotic use. A randomized trial conducted at two Mayo Clinic sites enrolled 101 parents of children aged six months and older who were diagnosed with non-severe AOM.
The study’s outcomes revealed significant improvements in parental knowledge and engagement among those utilizing the EPDA. Parents in the EPDA group scored an average of 6.1 on a knowledge assessment, compared to 5.1 in the usual care group, indicating a notable mean difference of 1.0. Similarly, clinician-parent engagement scores were higher in the EPDA group, reflecting better communication and understanding of the treatment options available.
Despite these favorable results, there were no significant differences in the rates of immediate antibiotic prescriptions between the two groups. The EPDA group had a 36% immediate prescription rate compared to 42% in the usual care group, suggesting that while parental knowledge improved, this did not translate into reduced antibiotic use.
Interaction time between clinicians and parents was found to be slightly longer for the EPDA group, with a median time of 4.2 minutes versus 3.0 minutes in the usual care group, although this difference was not statistically significant. The researchers emphasized that the increased engagement time positively correlated with the level of parental knowledge gained during the interaction.
Overall, while the study did not achieve its target enrollment, leading to potential limitations in statistical power, it underscored the importance of integrating shared decision-making tools in emergency care. The findings highlight the potential for decision aids to enhance communication between clinicians and families, despite the persistent challenges related to antibiotic overprescribing.
The research team concluded that further studies, particularly larger multicenter trials, are needed to evaluate the EPDA’s effectiveness in promoting antibiotic stewardship in pediatric acute otitis media. The study’s insights could pave the way for better clinical practices in managing AOM, ultimately benefiting children and their families.
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