Assessing the appropriateness of the management of otitis media in Australia: A population‐based sample survey
Aim Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) o...
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Published in | Journal of paediatrics and child health Vol. 56; no. 2; pp. 215 - 223 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Australia
John Wiley & Sons Australia, Ltd
01.02.2020
Blackwell Publishing Ltd |
Subjects | |
Online Access | Get full text |
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Abstract | Aim
Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children.
Methods
We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health‐care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children.
Results
We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health‐care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices.
Conclusions
Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME. |
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AbstractList | AimAcute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children.MethodsWe searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health‐care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children.ResultsWe reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health‐care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices.ConclusionsOur assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME. Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health-care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health-care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME. Aim Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. Methods We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health‐care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. Results We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health‐care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. Conclusions Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME. |
Author | Wiles, Louise Ting, Hsuen P Arnolda, Gaston Stephens, Jacqueline H Dalton, Chris Hallahan, Andrew Williams, Helena Hibbert, Peter Braithwaite, Jeffrey Clay‐Williams, Robyn |
Author_xml | – sequence: 1 givenname: Robyn orcidid: 0000-0002-6107-7445 surname: Clay‐Williams fullname: Clay‐Williams, Robyn email: robyn.clay-williams@mq.edu.au organization: Macquarie University – sequence: 2 givenname: Jacqueline H orcidid: 0000-0002-7278-1374 surname: Stephens fullname: Stephens, Jacqueline H organization: University of South Australia – sequence: 3 givenname: Helena surname: Williams fullname: Williams, Helena organization: Southern Adelaide Local Health Network – sequence: 4 givenname: Andrew surname: Hallahan fullname: Hallahan, Andrew organization: University of Queensland – sequence: 5 givenname: Chris surname: Dalton fullname: Dalton, Chris organization: Bupa ANZ – sequence: 6 givenname: Peter surname: Hibbert fullname: Hibbert, Peter organization: University of South Australia – sequence: 7 givenname: Hsuen P surname: Ting fullname: Ting, Hsuen P organization: Macquarie University – sequence: 8 givenname: Gaston surname: Arnolda fullname: Arnolda, Gaston organization: Macquarie University – sequence: 9 givenname: Louise surname: Wiles fullname: Wiles, Louise organization: University of South Australia – sequence: 10 givenname: Jeffrey orcidid: 0000-0003-0296-4957 surname: Braithwaite fullname: Braithwaite, Jeffrey organization: Macquarie University |
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Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to... Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase... AimAcute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to... AIMAcute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to... |
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SubjectTerms | Acute Disease acute otitis media Anti-Bacterial Agents - therapeutic use Antibiotics Australia Child Child, Preschool Clinical practice guidelines Ear diseases General Practice Guideline Adherence Humans Infant Infections Medical treatment otitis media Otitis Media - diagnosis Otitis Media - drug therapy Otitis Media with Effusion patient safety Pediatrics |
Title | Assessing the appropriateness of the management of otitis media in Australia: A population‐based sample survey |
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