title: Otitis media in Aboriginal children: the discordance between burden of illness and access to services in rural/remote and urban Australia.
abstract: OBJECTIVE
  To compare the burden of otitis media (OM) managed by Aboriginal Medical Service (AMS) practitioners and the availability of specialist ear health services in rural/remote versus urban Australian settings.
  
  
  METHODS
  We mailed questionnaires to all Australian AMS medical practitioners managing children in December 2006. Questions addressed the frequency of childhood OM cases seen, and the availability and waiting times for audiology; ear, nose and throat (ENT); and hearing-aid services. We compared rural/remote and urban practitioner's responses using the c2 test with clustering adjustments.
  
  
  RESULTS
  Questionnaires were returned by 63/87 (72%) AMSs and by 131/238 (55%) eligible practitioners. Rural/Remote practitioners reported managing a greater number of children with OM per week than urban practitioners (1 df, P = 0.02) and a larger proportion of the children they managed having OM (1 df, P = 0.009). More rural/remote than urban practitioners reported relevant services were not available locally: audiology (11.1 vs. 0%, P = 0.038), ENT (33.3 vs. 3.9%, P = 0.0004) and hearing-aid provision (37.7 vs. 1.9%, P < 0.0001). More rural/remote practitioners reported audiology waiting times longer than the recommended 3 months (18.3 vs. 1.9%, P = 0.007). Equal proportions reported ENT waiting times longer than the recommended 6 months (13.9 vs. 11.3%, P = 0.7).
  
  
  CONCLUSIONS
  Rural/Remote AMS practitioners manage a greater OM burden than urban AMS practitioners, but affected children have less access to specialist ear health services and longer waiting times. One in five rural/remote Aboriginal children wait longer than recommended for audiology testing, and one in eight Aboriginal children nationwide wait longer than recommended for ENT services.
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales 2145, Australia. hasanthg@chw.edu.au
authors.forename: Hasantha
authors.initials: H
authors.lastname: Gunasekera
authors.forename: Peter S
authors.initials: PS
authors.lastname: Morris
authors.forename: John
authors.initials: J
authors.lastname: Daniels
authors.forename: Sophie
authors.initials: S
authors.lastname: Couzos
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000328:Adult; D001298:Audiology; D001315:Australia / Q000453:epidemiology; D002648:Child; D005260:Female; D006297:Health Services Accessibility; D006303:Health Services, Indigenous; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010033:Otitis Media / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy; D010036:Otolaryngology; D010820:Physicians; D012423:Rural Health; D011795:Surveys and Questionnaires; D014504:Urban Health; D016526:Workload; D055815:Young Adult