J Clin Outcomes Manage
Low rates of adherence to 1999 acute otitis media treatment guidelines across pediatric and family practices
Walter EB, Yang H, Dolor RJ
Abstract Objective: To assess adherence to 1999 guidelines for the treatment of children with acute otitis media (AOM) across primary care specialties and to measure differences across specialties and practice types. Design: Retrospective record review. Patients and setting: 723 children aged 6 to 36 months who were diagnosed with suppurative otitis media in 2000 and received care at 1 of 4 primary care practice cohorts (university, community, pediatric, and family practice) within the Duke University Health System. Results: Adherence to guidelines was seen in 34% of episodes of AOM. Reasons for nonadherence included use of an alternate antimicrobial agent (46%) or suboptimal dosing of amoxicillin or amoxicillin-clavulanate (54%). Pediatricians were more likely than family practitioners to use high-dose amoxicillin or amoxicillin-clavulanate therapy (odds ratio [OR], 8.27; P < 0.001) and to follow treatment guidelines (OR, 3.70; P < 0.001). Guideline adherence was significantly lower in the treatment of children who had received prescriptions for antimicrobials in the past 3 months (OR, 0.58; P = 0.005), were younger than 2 years of age (OR, 0.48; P < 0.001), or had a history of antimicrobial allergy (OR, 0.50; P = 0.03). Conclusion: Rates of adherence to AOM treatment guidelines were low and varied between types of primary care practices.
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