Management of children with otitis media: a survey of Australian Aboriginal Medical Service practitioners.
OBJECTIVE
To determine whether Australian Aboriginal Medical Service (AMS) practitioners treat otitis media (OM) more aggressively in Aboriginal than non-Aboriginal children and the factors influencing their management decisions.


METHODS
A case vignette questionnaire was sent to all AMS practitioners working in December 2006. We compared responses based on the child's Aboriginal status using chi(2) analysis.


RESULTS
Questionnaires were returned from 63/87 (72%) of the AMSs by 131/238 (55%) eligible practitioners. Few practitioners (13%) reported using tympanometry or pneumatic otoscopy (9%) when examining children's ears. Practitioners were more likely to treat acute OM with antibiotics (92% vs. 49%, P < 0.01) and to treat with courses longer than 7 days (25% vs. 14%, P= 0.03) in Aboriginal than non-Aboriginal children. Most practitioners (60%) used oral antibiotics to treat chronic suppurative OM and OM with effusion in Aboriginal children (58%). Factors increasing the likelihood of antibiotic use included: the child being Aboriginal (67%), wet perforations (62%) and bulging eardrums (59%). No AMS or practitioner characteristics were significant predictors. Most practitioners (99%) were aware of Therapeutic Guidelines (Antibiotic). Only half (54%) were aware of the Australian Government guidelines for managing OM in Aboriginal and Torres Strait Islander populations and only 22% used them 'often' or 'always'.


CONCLUSIONS
Australian AMS practitioners treat OM more aggressively in Aboriginal children, consistent with the Australian Government guidelines, despite half being unaware of them. Opportunities to improve management include increased use of pneumatic otoscopy and tympanometry, and decreased antibiotic usage for OM with effusion and chronic suppurative OM.
Gunasekera
Hasantha
H
Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia. hasanthg@chw.edu.au
Morris
Peter S
PS
Daniels
John
J
Couzos
Sophie
S
Craig
Jonathan C
JC
D000158:Acoustic Impedance Tests; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D002648:Child; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006303:Health Services, Indigenous; D006801:Humans; D008297:Male; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D038781:Otoscopy; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D055815:Young Adult
D000900:Anti-Bacterial Agents