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Physician specialty is associated with adherence to treatment guidelines for acute otitis media in children
Zachi Grossman1, Barbara G Silverman, Dan Miron
1Maccabi Health Services, Tel Aviv, Israel. zgrosman@netvision.net.il
Insights
Delayed antibiotic therapy for acute otitis media (AOM) is challenging. Family physicians, weekend visits, urgent care, and peripheral locations are linked to earlier antibiotic use in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Services Research
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Guidelines recommend delayed antibiotic therapy for AOM to curb antibiotic resistance.
- Physician and visit characteristics may influence adherence to these guidelines.
Purpose of the Study:
- To identify physician and visit characteristics affecting adherence to delayed antibiotic therapy guidelines for AOM.
- To analyze factors influencing early antibiotic treatment rates in pediatric AOM cases.
Main Methods:
- Retrospective analysis of physician visit data from an Israeli health maintenance organization.
- Inclusion of children aged 0-15 diagnosed with AOM.
- Definition of early antibiotic treatment as purchase within 3 days of diagnosis.
- Assessment of physician specialty, day of week, setting, and clinic location.
Main Results:
- Early antibiotic treatment rates decreased for otolaryngologists and pediatricians but increased for family physicians from 2002-2009.
- Higher rates of early treatment were observed on weekends, in urgent care settings, and in peripheral areas.
- Significant disparities in early treatment rates were noted based on physician specialty and geographic location.
Conclusions:
- Adherence to delayed antibiotic therapy guidelines for AOM is variable.
- Factors such as physician specialty, visit setting, and patient location influence early antibiotic prescribing.
- Targeted interventions addressing these characteristics are crucial for successful guideline implementation.
Aim:
To identify physician and visit characteristics affecting adherence to guidelines recommending delayed antibiotic therapy for acute otitis media (AOM).
Methods:
We used physician visit data from an Israeli health maintenance organization to identify children ages 0-15 diagnosed with AOM. We defined early antibiotic treatment as purchase, within 3 days of diagnosis, of antibiotics prescribed by the diagnosing physician. We considered the effect of physician specialty (paediatrician, otolaryngologist, and family physician), day of the week, setting (urgent care/clinic) and clinic location (peripheral/central) on the rate of early treatment.
Results:
Proportion of cases receiving early treatment dropped from 2002 to 2009 in cases treated by otolaryngologists (47-36%) and paediatricians (46-42%) and increased in cases treated by family physicians (43-50%). Treatment rate was higher in cases treated on weekends than on weekdays (48% vs. 44%), in urgent care as compared to clinic settings (51% vs. 44%), and in children living in peripheral as compared to central areas (52% vs. 38%).
Conclusions:
Successful implementation of delayed treatment of otitis media guidelines requires addressing factors associated with increased early treatment rates.
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