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The use of practice guidelines in the management of pediatric cases of Acute Otitis Media in Amman, Jordan.

Abstract The widespread emergence of antimicrobial resistance has led many healthcare institutions to adopt more conservative antibiotic prescription practice guidelines for the treatment of acute otitis media (AOM). Little is known about the awareness and use of such guidelines by physicians in Jordan. Our aim was to pilot an anonymous survey instrument that would assess AOM treatment trends as well as awareness of and adherence to practice guidelines in Amman. By qualitatively assessing the management of AOM we could illuminate possible disparities in treatment trends, evaluate variability in practice guideline adherence, and help focus efforts of future educational programs that pertain to pediatric AOM management.
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Authors

Mayor MeshTerms
Keywords

Acute Otitis Media

Amman Jordan

Practice guideline adherence

Journal Title international journal of pediatric otorhinolaryngology
Publication Year Start




PMID- 28390611
OWN - NLM
STAT- In-Process
DA  - 20170409
LR  - 20170409
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Linking)
VI  - 96
DP  - 2017 May
TI  - The use of practice guidelines in the management of pediatric cases of Acute
      Otitis Media in Amman, Jordan.
PG  - 39-46
LID - S0165-5876(17)30084-8 [pii]
LID - 10.1016/j.ijporl.2017.02.024 [doi]
AB  - OBJECTIVES: The widespread emergence of antimicrobial resistance has led many
      healthcare institutions to adopt more conservative antibiotic prescription
      practice guidelines for the treatment of acute otitis media (AOM). Little is
      known about the awareness and use of such guidelines by physicians in Jordan. Our
      aim was to pilot an anonymous survey instrument that would assess AOM treatment
      trends as well as awareness of and adherence to practice guidelines in Amman. By 
      qualitatively assessing the management of AOM we could illuminate possible
      disparities in treatment trends, evaluate variability in practice guideline
      adherence, and help focus efforts of future educational programs that pertain to 
      pediatric AOM management. METHODS: A total of 71 practicing physicians were
      anonymously surveyed in Amman, Jordan. The survey assessed awareness of and
      adherence to practice guidelines by prompting responses to hypothetical AOM
      cases. Differences in performance between various physician groups were noted.
      RESULTS: In total, participants answered 61.2% of the questions correctly. It was
      found that trainees would prescribe more appropriate antibiotics relative to
      attending physicians (p = 0.008). It was found that medical physicians followed
      guidelines more appropriately relative to ENT surgeons (64.2% of questions
      answered correctly vs. 58.1% of questions answered correctly; p = 0.015) and that
      physicians who report adhering to guidelines all/most of the time followed
      guidelines more appropriately relative to those who report adhering only
      sometimes or never (64.0% of questions answered correctly vs. 58.0% of questions 
      answered correctly; p = 0.011). Also, cases that dealt with children were the
      most difficult for participants to diagnose as compared with cases that dealt
      with adults. CONCLUSION: We conducted the first known qualitative analysis of
      otitis media practices in Amman and found numerous shortcomings in AOM guideline 
      familiarity. Awareness of practice guidelines can lead to more appropriate AOM
      management, but there is variability between groups in guideline familiarity and 
      utilization. Interventions that promote more conservative antibiotic
      prescriptions could be targeted towards groups that prescribe antibiotics less
      appropriately relative to their colleagues e.g. attending physicians and ENT
      surgeons. Interventions could also target physicians who manage pediatric AOM
      cases as participants had the most difficulty in properly diagnosing cases that
      involved children and infants.
CI  - Copyright (c) 2017 Elsevier B.V. All rights reserved.
FAU - Khreesha, Lubna
AU  - Khreesha L
AD  - Otolaryngology, Department of Special Surgeries, Faculty of Medicine, University 
      of Jordan, Amman, Jordan.
FAU - Bacharouch, Ali
AU  - Bacharouch A
AD  - University of Michigan Medical School, Ann Arbor, MI, USA.
FAU - Blackwood, R Alexander
AU  - Blackwood RA
AD  - Department of Pediatrics and Communicable Diseases, Associate Professor of
      Pediatric Infectious Diseases, University of Michigan Medical School, Ann Arbor, 
      MI, USA. Electronic address: [email protected]
FAU - Alkhoujah, Mohammed
AU  - Alkhoujah M
AD  - University of Jordan, Amman, Jordan.
FAU - Issa, Mohamad R
AU  - Issa MR
AD  - University of Pittsburgh Department of Otolaryngology, Pittsburgh, PA, USA.
LA  - eng
PT  - Journal Article
DEP - 20170227
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
OTO - NOTNLM
OT  - Acute Otitis Media
OT  - Amman Jordan
OT  - Practice guideline adherence
EDAT- 2017/04/10 06:00
MHDA- 2017/04/10 06:00
CRDT- 2017/04/10 06:00
PHST- 2016/10/17 [received]
PHST- 2017/02/22 [accepted]
AID - S0165-5876(17)30084-8 [pii]
AID - 10.1016/j.ijporl.2017.02.024 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2017 May;96:39-46. doi:
      10.1016/j.ijporl.2017.02.024. Epub 2017 Feb 27.

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