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Reducing antibiotic duration for acute otitis media: clinician, administrator, and parental insights to inform
Deborah J Rinehart1,2, Aiden Gilbert1, Sonja O'Leary3,4
1Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, Denver, CO, USA.
Insights
This study explored barriers and facilitators for reducing antibiotic duration in pediatric acute otitis media (AOM). Clinicians and parents are receptive to interventions, but more parent education on antibiotic stewardship is needed.
Area of Science:
- Pediatric infectious diseases
- Antibiotic stewardship
- Implementation science
Background:
- Guideline-concordant antibiotic prescribing for pediatric acute otitis media (AOM) is suboptimal.
- Interventions are needed to optimize antibiotic prescribing duration.
- Understanding implementation facilitators and barriers is crucial for successful interventions.
Purpose of the Study:
- To identify facilitators and barriers to implementing interventions aimed at improving guideline-concordant antibiotic duration prescribing for pediatric AOM.
- To gather clinician and parent perspectives on optimizing antibiotic prescribing.
Main Methods:
- Qualitative study employing semi-structured interviews with clinicians and clinic administrators.
- Focus groups were conducted with parents of children diagnosed with AOM.
- The Practical Robust Implementation and Sustainability Model (PRISM) framework guided the study.
- Data analysis utilized the Rapid Assessment Process.
Main Results:
- Thirty-one participants (15 clinicians, 4 administrators, 12 parents) were included.
- Key factors influencing prescribing included patient history, clinician experience, patient familiarity, adherence concerns, and practice type.
- Clinicians favored electronic health record modifications and prescribing feedback for improving care and reducing antibiotic duration.
- Intervention optimization suggestions and educational needs were identified.
Conclusions:
- Clinicians and administrators are supportive of reducing antibiotic durations for AOM and receptive to proposed interventions.
- Enhanced parent education is necessary to improve awareness of antibiotic stewardship and AOM treatment options.
Objective:
This qualitative study aimed to understand facilitators and barriers to implementation of interventions to improve guideline-concordant antibiotic duration prescribing for pediatric acute otitis media (AOM).
Design:
Clinicians and clinic administrators participated in semi-structured qualitative interviews, and parents of children 2 years of age or older with a recent diagnosis of AOM participated in focus groups. The Practical Robust Implementation and Sustainability Model (PRISM) guided the study. Interviews were analyzed using the Rapid Assessment Process.
Setting:
Denver Health and Hospital Authority (Denver, CO) led the study. Recruitment occurred at Vanderbilt University Medical Center (Nashville, TN) and Washington University in St. Louis Medical Center (St. Louis, MO).
Participants:
Purposeful sampling was used to recruit clinicians and administrators for qualitative interviews. Convenience sampling was used to recruit parents for focus groups.
Results:
Thirty-one participants (15 clinicians, 4 administrators, and 12 parents) engaged in interviews and focus groups. Factors influencing antibiotic prescribing included patient history, years of practice, familiarity with the patient, concerns with patient medication adherence, and practice type. Clinicians endorsed electronic health record modifications and clinician prescribing feedback as methods to improve patient care and reduce the durations of prescribed antibiotics. Suggestions for intervention optimization and education needs were also obtained.
Conclusions:
Findings suggest that clinicians and administrators support reducing prescribed antibiotic durations for AOM and are receptive to the proposed interventions. More education is needed to increase parent awareness about antibiotic stewardship and AOM treatment options.
Clinical Trials Identifier:
RELAX: Reducing Length of Antibiotics for Children with Ear Infections (RELAX), NCT05608993, https://clinicaltrials.gov/study/NCT05608993.
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