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Does a paediatric after-hours clinic use evidence-based guidelines in the management of acute otitis media?
Jonathon L Maguire1, Jane Healey, Hartley Garfield
1Department of Pediatrics, Faculty of Medicine, University of Toronto;
Insights
A paediatric after-hours clinic demonstrated high adherence to evidence-based guidelines for acute otitis media, prescribing appropriate antibiotic doses and utilizing fewer investigations compared to hospital emergency departments.
Area of Science:
- Pediatric Otolaryngology
- Evidence-Based Medicine
- Healthcare Management
Background:
- Acute otitis media (AOM) is a common childhood illness requiring appropriate management.
- Variations in treatment protocols exist across different healthcare settings.
- Evaluating adherence to clinical guidelines is crucial for optimizing patient care and resource utilization.
Purpose of the Study:
- To assess the evidence-based management of acute otitis media in a paediatric after-hours clinic.
- To compare the clinic's treatment approach with that of paediatric and general hospital emergency departments.
Main Methods:
- Retrospective chart review of 573 children (6 months to 5 years) diagnosed with AOM.
- Analysis of antibiotic choice, dosage, duration, and use of investigations.
- Comparison across three settings: paediatric after-hours clinic, paediatric ED, and general hospital ED.
Main Results:
- Amoxicillin prescription rates were similar (68%) in the paediatric after-hours clinic and paediatric ED, higher than the general ED (53%).
- Mean amoxicillin doses were higher in the paediatric after-hours clinic and paediatric ED compared to the general ED.
- Investigations were utilized significantly less in the paediatric after-hours clinic (0.5%) versus EDs (9-20%).
Conclusions:
- The paediatric after-hours clinic exhibits high adherence to clinical practice guidelines for AOM treatment.
- This clinic demonstrates efficient resource management through reduced utilization of intensive investigations.
Objective:
To determine whether a paediatric after-hours clinic uses evidence-based management in the treatment of acute otitis media, and compare this management with that provided in a paediatric emergency department and a general hospital emergency department.
Methods:
A retrospective chart review of 573 patients (aged six months to five years) with a discharge diagnosis of acute otitis media was conducted in three after-hours settings: a paediatric after-hours clinic, a tertiary paediatric hospital emergency department and a secondary general hospital emergency department. The patients' age, weight, sex and allergy to antibiotics were recorded as baseline characteristics. The physicians' antibiotic choice, dose and duration, and the use of investigations were recorded as outcome variables.
Results:
Amoxicillin was prescribed to 68% of patients at both the paediatric after-hours clinic and the paediatric hospital emergency department, compared with 53% of patients at the general hospital emergency department (P<0.01). The mean dose of amoxicillin prescribed at the paediatric after-hours clinic and the paediatric hospital emergency department were similar (43.4±9.7 mg/kg per day and 42.4±14.3 mg/kg per day, respectively) and higher than that prescribed at the general hospital emergency department (38.6±8.8 mg/kg per day, P<0.01). The paediatric after-hours clinic used investigations less often than did emergency departments (0.5% of cases compared with 9% and 20%, P<0.01).
Conclusion:
The paediatric after-hours clinic provided a high level of adherence to a clinical practice guideline and had a low utilization of resource intensive investigations.
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