Management of children with otitis media: A survey of Australian Aboriginal Medical Service practitioners

Self Cite

Section: Methodsmentioning

confidence: 99%

Otitis media in Aboriginal children: The discordance between burden of illness and access to services in rural/remote and urban Australia

Gunasekera

Morris

Daniels

et al. 2009

Self Cite

“…For example, in data sourced from a US insurance company, receipt of psychology therapy by children with attention‐deficit/hyperactivity disorder varied by county from 6.3% to 38.1%, and this variation occurred even across counties with a similar number of psychologists . Use of an otoscope or tympanometry to diagnose otitis media in Aboriginal children was also underutilised …”

Section: Executive Summarymentioning

confidence: 99%

“…8 Use of an otoscope or tympanometry to diagnose otitis media in Aboriginal children was also underutilised. 9 ED care -24 studies; asthma was the most common condition (seven studies), followed by bronchiolitis and fever (four each), pneumonia (three), analgesia/sedation and concussion (two each). Three studies were from Australia.…”

Section: Executive Summarymentioning

confidence: 99%

Variation in paediatric clinical practice: A review of care in inpatient, outpatient and emergency department settings

Perera

McLean

Roberts

et al. 2016

Hospital Boston, noted the following: 'If all variation were bad then solutions would be easy. The difficulty is in reducing bad variation, which reflects the limits of professional knowledge, and failures in its application, whilst preserving the good variation that makes care patient centred.' 1 Variation in care refers to variation in diagnostic and treatment practices, including medications prescribed, imaging and pathology ordered, procedures and interventions performed, and referrals made. It is important because it inevitably reflects variation in quality of care and associated costs. Whilst the British Medical Journal editorial statement is undoubtedly true, there is little published about variation in paediatric clinical practice. Before paediatricians and policy makers can begin to sort 'good' or warranted from 'bad' or unwarranted variation, we need a deeper understanding within paediatric practice of where variation occurs, what aspects are considered to be warranted or unwarranted and whether there are modifiable, systems-based factors that can reduce the latter. To this end, the then NSW Kids and Families commissioned a rapid review of the evidence of variation in paediatric clinical care in inpatient, outpatient and emergency department (ED) settings. The full review was published in November 2014 and is available at https://www.saxinstitute.org.au/publications/evidencecheck-library/variation-in-paediatric-clinical-practice/.2 A rapid review is a form of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a timely manner (e.g. omission of study quality ratings, as per this review). 3 The review focused on variation in care in developed countries for 16 common child health conditions and systemic factors associated with this variation. The following databases were searched: Ovid MEDLINE, CINAHL (EBSCO), PsychInfo, Cochrane library and PubMed, as well as published reviews, and references of retrieved, relevant articles. This paper presents an executive summary of the review along with research and policy implications arising. Executive SummaryVariation in paediatric clinical care is common. It occurs across diseases, clinicians and settings. Wennberg's framework is the most common framework used to understand variation in clinical care. 4It describes both warranted and unwarranted variation, with unwarranted variation being defined as 'variation that cannot be explained by type or severity of illness or by patient preferences'. Unwarranted variation is further categorised as variation in the following:• effective care, that is, when proven, clinically effective care is not used; • preference-sensitive care, that is, where there are two or more choices for care and the choice made is ideally be driven by patient preferences; and • supply-sensitive care, that is, when variation arises not due to evidence but due to supply of health-care resources such as doctors or diagnostic services. The review found widespread variation across...

“…For Aboriginal and Torres Strait Islander children, adherence to guidelines with respect to prescribing antibiotics (97%; OTIT08) was similar to that reported in a 2008 survey of vignette responses by medical practitioners working in Aboriginal Medical Service (92%). 46 The 2008 study found that 25% would treat AOM with courses of longer than 7 days, while our study found only 13% treating for 7 days (OTIT13); we only counted compliance if 50 mg/kg/day of amoxicillin was prescribed as per Australian Health Department recommendations for clinical management of otitis media in Aboriginal and Torres Strait Islander populations. 47 Adherence to treatment guidelines for Aboriginal and Torres Strait Islander children may impact later quality of life for these populations.…”

Section: Comparison With Other Studiesmentioning

confidence: 85%

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

Clay‐Williams

Stephens

Williams

et al. 2019

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.