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Deborah B. McWilliams, MD; Robert M. Jacobson, MD; Holly K. Van Houten, BA; James M. Naessens, ScD, MPH; Karen L. Ytterberg, MD, MHSA

Arch Pediatr Adolesc Med. 2008;162(2):151-156.

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.

Author Affiliations: Division of Community Pediatric and Adolescent Medicine (Drs McWilliams, Jacobson, and Ytterberg) and Department of Health Sciences Research (Ms Van Houten and Dr Naessens), Mayo Clinic, Rochester, Minnesota.

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