Adopting otitis media practice guidelines increases adherence within a large primary care network.


Bradley M(1), Bacharouch A(2), Hart-Johnson T(3), Burrows HL(4), Blackwood RA(3)(4).
Author information:
(1)University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan, United States.
(2)University of Michigan Medical School, Ann Arbor, Michigan, United States.
(3)Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan, United States.
(4)Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States.


AIM: Unnecessary antibiotic prescriptions to treat otitis media (OM) contribute to adverse drug reactions, increased cost and antibiotic resistance. Clinical care guidelines can help promote consistent treatment of conditions such as OM. This study evaluates adherence before and after implementation of an institutional guideline for the diagnosis and treatment of paediatric OM. METHODS: A retrospective chart review was performed to collect encounter information for paediatric patients seen within a primary care clinic network and diagnosed with OM before and after full implementation of a clinical care guideline. Patient cohorts from 2013 and 2016 were compared to determine which factors, including age, symptoms and diagnosis, were associated with treatment guideline adherence. RESULTS: Comparison of encounters from 2013 (n = 418) to 2016 (n = 635) revealed a significant difference in adherence to the 2013 Michigan Medicine Otitis Media Guideline. Overall adherence increased from 61.2% in 2013 to 70.6% in 2016 (χ2  = 9.85, P < 0.0017). Antibiotic use for acute OM decreased from 99.7% in 2013 to 96.7% in 2016 (χ2  = 10.04, P = 0.0015). Antibiotic prescriptions for OM with effusion decreased significantly from 42.9% in 2013 to 17.4% in 2016 (χ2  = 11.93, P < 0.0006). CONCLUSION: Implementation of an institutional OM clinical practice guideline contributed to a significant increase in overall treatment adherence of OM for paediatric patients between the 2013 and 2016 cohorts. The number of antibiotic prescriptions for paediatric patients diagnosed with acute OM or OM with effusion significantly decreased from 2013 to 2016.