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Adherence to Tympanostomy Tube Clinical Practice Guidelines in an Advanced Practice Provider Clinic
Edward S Sim1, Michael A Belsky1, Anisha Konanur1
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Advanced practice providers (APPs) demonstrate similar adherence to clinical practice guidelines (CPGs) for recurrent acute otitis media (RAOM) as otolaryngologists (OTOs). This study found APP-led clinics effectively manage RAOM, supporting evidence-based care.
Area of Science:
- Otolaryngology
- Pediatric Healthcare
- Evidence-Based Medicine
Background:
- Recurrent acute otitis media (RAOM) is a common pediatric condition requiring guideline-based management.
- The 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) provides recommendations for RAOM treatment.
- Adherence to CPGs ensures optimal patient outcomes and resource utilization.
Purpose of the Study:
- To compare the adherence rates of attending otolaryngologists (OTOs) and advanced practice providers (APPs) to the CPG for RAOM.
- To evaluate the effectiveness of APP-led clinics in managing RAOM.
- To assess agreement between pre-operative and surgical-time middle ear effusion identification.
Main Methods:
- Retrospective review of patients aged 6 months to 12 years undergoing bilateral myringotomy and tympanostomy tube placement (BMT) for RAOM.
- Patients were categorized based on whether they were seen by an OTO or an APP pre-operatively.
- CPG adherence was determined by the presence of middle ear effusion or meeting exception criteria.
Main Results:
- Nine hundred twenty-three patients were included; 601 seen by OTOs and 322 by APPs.
- Middle ear effusion was identified pre-operatively in 84% of APP patients versus 76% of OTO patients (P=.005).
- Overall adherence to CPG or exception criteria was higher for APPs (92%) compared to OTOs (87%) (P=.037). Provider type did not significantly impact agreement between pre-op and surgical-time effusion identification.
Conclusions:
- Independent APP-led clinics can effectively manage RAOM with high adherence to CPGs.
- APP management of RAOM demonstrates comparable or superior adherence rates to CPGs compared to OTOs.
- This supports the integration of APPs in delivering evidence-based care for RAOM.
Objective:
We compared adherence rates by attending otolaryngologists (OTOs) and advanced practice providers (APPs) to the 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) for children with recurrent acute otitis media (RAOM) undergoing bilateral myringotomy and tympanostomy tube placement (BMT).
Methods:
Patients aged 6 months to 12 years old undergoing BMT for RAOM who had a pre-operative visit with an independent APP or OTO were reviewed. Patients satisfied CPG criteria if middle ear effusion was identified at the pre-operative visit (pre-op) or if they did not have effusion but met exception criteria based on their risk for developmental difficulties and contraindications to medical therapy. Adherence rates between APPs and OTOs were compared. Agreement between pre-op and time-of-surgery middle ear effusion identification was assessed.
Results:
Nine hundred twenty-three patients were included. Six hundred one patients were seen by OTOs and 322 by APPs. Middle ear effusion was identified at pre-op in 84% of APP patients and in 76% of OTO patients (P = .005). Eight percent of APP patients and 11% of OTO patients met exception criteria (P = .138). Overall, 87% of OTO patients and 92% of APP patients met either CPG or exception criteria for BMT (P = .037). A logistic regression model demonstrated that pre-op provider type did not significantly impact rates of agreement between pre-op visit and time-of-surgery middle ear effusion identification.
Conclusions:
Independent APP-led clinics can reliably and effectively deliver evidence-based care for prevalent conditions such as RAOM at similar rates of adherence to CPGs as OTOs.
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