Education campaign fails to improve guideline adherence in paediatric AOM

By Joanna Lyford, Senior medwireNews Reporter

Swedish researchers report that overall adherence to treatment guidelines for acute otitis media (AOM) in children is good, at 70–90%, but that adherence to watchful waiting is poor.

The survey follows an information campaign designed by the researchers to improve adherence to recommendations, and the results suggest the need for more work to identify specific barriers to guideline implementation other than lack of knowledge.

AOM is the second-most common infectious diagnosis in children and the primary reason for paediatric antibiotic prescription. In an attempt to limit antimicrobial resistance, Swedish treatment guidelines since 2000 have recommended watching waiting as the first-line approach in children aged 2 years and over unless they have specific risk factors.

In this study, Jimmy Célind and colleagues, from the University of Gothenburg in Sweden, used patient records to see whether the management of AOM changed after an information campaign. They analysed information on 91 children treated before and 80 treated after the campaign. All were treated at paediatric emergency department of a university hospital.

Writing in the International Journal of Pediatric Otorhinolaryngology, the team reports that none of the primary outcome measures – use of drugs as opposed to non-drug management, choice of drug, drug dosage or duration of drug treatment – changed significantly between the two study periods.

Adherence to specific guideline recommendations ranged from 70% for antibiotic dosage to 90% for treatment duration before the information campaign. Afterwards, adherence ranged from 75% for the choice to use drugs to 94% for treatment duration. The changes between the primary endpoints before and after the campaign were not statistically significant.

Célind and colleagues offer several possible explanations for the lack of improvement in adherence, including the prescription of antibiotics for AOM despite guideline recommendations for watchful waiting in the majority of children.

One is that their campaign consisted of a single presentation and distribution of educational materials and did not monitor or give feedback to individuals; patient education was also very limited.

Another reason is that the campaign was delivered by paediatric physicians rather than key opinion leaders. Also, the hospital setting, with its lengthy wait times, may have caused families and physicians to be more keen to treat immediately and potentially avoid a second visit.

“Fear of complications outweighs the guilt over bad adherence to guidelines, especially guidelines recommending that something should not be done”, they write.

The authors conclude: “This study has shown that an ambitious campaign to spread information about recommendations among prescribers was not enough to improve adherence to recommendations regarding AOM treatment, even in the areas where adherence was poor.

“This suggests that there are either important barriers to adherence to AOM guidelines other than lack of knowledge of the recommendations, or that the educational power of this intervention was insufficient.”

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