Adherence to treatment guidelines for acute otitis media in children. The necessity of an effective strategy of guideline implementation

Célind, Jimmy; Södermark, Liv; Hjalmarson, Ola

doi:10.1016/j.ijporl.2014.04.029

Cited by 31 publications

(28 citation statements)

References 22 publications

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“…In the Netherlands, an intervention that included education and feedback was found to reduce prescribing rates in primary care for respiratory tract infections . On the other hand, a Swedish information campaign to improve care provider knowledge about treatment guidelines for treating AOM did not improve overall provider compliance with the guidelines . One avenue that shows promise is the use of clinical decision support, which has been found to improve guideline uptake by clinicians with the lowest adherence prior to the study …”

Section: Discussionmentioning

confidence: 99%

“…52,53 On the other hand, a Swedish information campaign to improve care provider knowledge about treatment guidelines for treating AOM did not improve overall provider compliance with the guidelines. 54 One avenue that shows promise is the use of clinical decision support, which has been found to improve guideline uptake by clinicians with the lowest adherence prior to the study. 55 A systematic review examining interventions to improve the treatment of upper respiratory tract infections (including otitis media) found that computer interventions and multifaceted interventions (checklists, education, printed material) appeared to be the most effective in improving provider adherence to guidelines and appropriate antibiotic prescribing.…”

Section: Potential Interventionsmentioning

confidence: 99%

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

Clay‐Williams

Stephens

Williams

et al. 2019

J Paediatrics Child Health

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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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Section: Discussionmentioning

confidence: 99%

Section: Potential Interventionsmentioning

confidence: 99%

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

Clay‐Williams

Stephens

Williams

et al. 2019

J Paediatrics Child Health

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“…Information alone seems ineffective, which could be attributed to either the insufficient educational power of these educational interventions or other barriers to their implementation (eg, cultural/social beliefs about the benefits and harms of antibiotics). 78 Targeting specific scenarios associated with immediate vs delayed or no antibiotics prescribing for AOM (eg, diagnosis on weekends vs weekdays, urgent care vs clinical setting, family care vs specialist care) may be effective in reducing unnecessary prescribing. 82 Electronic health record-based clinical decision support and performance feedback systems were found effective in improving adherence to OM guidelines; combining these 2 interventions, however, was no better than either delivered alone.…”

Section: Impact Of Guidelinesmentioning

confidence: 99%

Panel 7: Otitis Media: Treatment and Complications

Schilder

Marom²,

Bhutta

et al. 2017

Otolaryngol.--head neck surg.

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Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.

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“…A recent study investigated the effects of an implementation of national guidelines for acute otitis media in a Swedish paediatric hospital [161]. That implementation strategy was labelled an information campaign, and comprised distribution of printed educational material, presentation at weekly meetings, and patient leaflets.…”

Section: … In Sweden (Non-physioterapy Settings)mentioning

confidence: 99%

Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences

Bernhardsson¹

2015

Linköping University Medical Dissertations

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Adherence to treatment guidelines for acute otitis media in children. The necessity of an effective strategy of guideline implementation

Cited by 31 publications

References 22 publications

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

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

Panel 7: Otitis Media: Treatment and Complications

Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences

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