Video Discharge Instructions for Acute Otitis Media
Condition: Otitis Media
MeSH terms: Otitis; Otitis Media
Study type: Interventional

Summary: 
      Thorough, understandable discharge instructions empower caregivers, allowing them to provide
      optimum care of their children during illness. Unfortunately discharge instructions are often
      incomplete and difficult to understand. The use of video discharge instructions has been
      shown to increase patient understanding of their illness. The investigators would like to
      know if using video discharge instructions for caregivers of children with middle ear
      infections helps to better understand how to take care of children at home, potentially
      allowing the child to feel better faster. The investigators will be comparing video discharge
      instructions to a paper handout to see if the former leads to improved well-being of the
      child and improved caregiver knowledge, satisfaction and anxiety.
    

Detailed description: 
      Providing patients with understandable, comprehensive discharge instructions improves
      compliance, thereby reducing symptoms and the functional impact of illness. Comprehensive
      discharge instructions also reduce patient anxiety and increases satisfaction. Unfortunately,
      in a busy emergency department (ED), discharge instructions are often incomplete.
      Furthermore, even when discharge instructions have been provided, patients often have
      difficulty comprehending and/or recalling them. Inadequate discharge instructions are linked
      to medication errors, suboptimal care post-discharge, and unnecessary return visits to the
      ED. Patient dissatisfaction with discharge instructions and anxiety have also been linked to
      poor medication compliance, and an increase in return visits.

      Studies have demonstrated that knowledge of pediatric medical conditions can be enhanced
      through the use of video technology. Specifically, it has been shown that when video
      discharge instructions are used in place of, or to complement written discharge instructions,
      patients have a better understanding of their illness and report higher rates of
      satisfaction. However, no studies to date have explored if clinically relevant outcomes such
      as symptomatology, function and recidivism can be improved.

      This study will examine the utility of video discharge instructions for the diagnosis of
      acute otitis media (AOM), a leading cause of health care visits among children. AOM affects
      up to 75% of children before school-age and is the most common illness for which antibiotics
      are prescribed to children in the United States. In Canada, AOM is associated with
      substantial use of health services (3.1 hours in an emergency department and 1.8 hours in an
      outpatient clinic on average per visit) and significantly burdens caregivers in the form of
      time spent on medical consultations, and time taken off from work. An American study
      estimated that the cost of one episode of AOM in a 3-month period following diagnosis was
      $1330.58, with the majority of that cost stemming from the indirect costs of illness, 90% of
      which was accrued primarily by parental time off work. In Quebec, the total annual cost to
      the health care system for otitis media and placement of tympanostomy tubes is more than $10
      million dollars.

      Pain is often substantial in the early course of AOM. Poorly controlled pain is associated
      with suffering and can be emotionally traumatic, causing anxiety for patients and their
      caregivers. Efficacious treatment for child pain is paramount in preventing protracted
      sensitivity to pain. Despite the magnitude of effects that acute pain can have on a child, it
      is often inadequately assessed and treated. In children less than two years of age, 30% of
      children continue to experience pain, fever, or both for up to 7 into the illness, thus
      highlighting the importance of caregiver education on symptom management.

      Recurrent AOM is common, 5-15% of children under the age of 2 experience four or more
      episodes per year. Caregivers of children with recurrent AOM not only judge their child's
      quality of life markedly lower than caregivers of children of a general population, but also
      lower than those of children with mild-to-moderately severe chronic conditions. Although
      uncommon, AOM also has the potential to cause serious complications such as, mastoiditis and
      bacterial meningitis, if not treated and monitored appropriately.

      The investigators hypothesize that video discharge instructions directed at caregivers of
      children with AOM will be associated with improved symptomatology and functional outcomes,
      along with improved caregiver knowledge, satisfaction, and anxiety compared to the standard
      of care, paper-based discharge instructions.
    

Intervention name(s): Video discharge instructions; Standard of Care
Intervention type(s): Other; Other
Intervention description(s): Online video containing information on how to manage symptoms of acute otitis media and when to return to a health care professional.; One page paper handout containing information on how to manage symptoms of acute otitis media and when to return to a health care professional.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment