Assessing the appropriateness of the management of otitis media in Australia: A population-based sample survey

CareTrack Kids Investigative Team, Robyn Clay-Williams, Jacqueline H Stephens, Helena Williams, Andrew Hallahan, Chris Dalton, Peter Hibbert, Hsuen P Ting, Gaston Arnolda, Louise Wiles, Jeffrey Braithwaite

Research output: Contribution to journalArticle

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.

LanguageEnglish
JournalJournal of Paediatrics and Child Health
DOIs
Publication statusE-pub ahead of print - 17 Jul 2019

Keywords

  • Assessing
  • appropriateness
  • Australia
  • population‐based
  • survey

Cite this

@article{fc981d853be74d7fa419d2c94c01a8cf,
title = "Assessing the appropriateness of the management of otitis media in Australia: A population-based sample survey",
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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author = "{CareTrack Kids Investigative Team} and Robyn Clay-Williams and Stephens, {Jacqueline H} and Helena Williams and Andrew Hallahan and Chris Dalton and Peter Hibbert and Ting, {Hsuen P} and Gaston Arnolda and Louise Wiles and Jeffrey Braithwaite",
note = "{\circledC} 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).",
year = "2019",
month = "7",
day = "17",
doi = "10.1111/jpc.14560",
language = "English",
journal = "Journal of Paediatrics and Child Health",
issn = "1034-4810",
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Assessing the appropriateness of the management of otitis media in Australia : A population-based sample survey. / CareTrack Kids Investigative Team.

In: Journal of Paediatrics and Child Health, 17.07.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Assessing the appropriateness of the management of otitis media in Australia

T2 - Journal of Paediatrics and Child Health

AU - CareTrack Kids Investigative Team

AU - Clay-Williams, Robyn

AU - Stephens, Jacqueline H

AU - Williams, Helena

AU - Hallahan, Andrew

AU - Dalton, Chris

AU - Hibbert, Peter

AU - Ting, Hsuen P

AU - Arnolda, Gaston

AU - Wiles, Louise

AU - Braithwaite, Jeffrey

N1 - © 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

PY - 2019/7/17

Y1 - 2019/7/17

N2 - 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.

AB - 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.

KW - Assessing

KW - appropriateness

KW - Australia

KW - population‐based

KW - survey

U2 - 10.1111/jpc.14560

DO - 10.1111/jpc.14560

M3 - Article

JO - Journal of Paediatrics and Child Health

JF - Journal of Paediatrics and Child Health

SN - 1034-4810

ER -