title: Does a paediatric after-hours clinic use evidence-based guidelines in the management of acute otitis media?
abstract: OBJECTIVE
  To determine whether a paediatric after-hours clinic uses evidence-based management in the treatment of acute otitis media, and compare this management with that provided in a paediatric emergency department and a general hospital emergency department.
  
  
  METHODS
  A retrospective chart review of 573 patients (aged six months to five years) with a discharge diagnosis of acute otitis media was conducted in three after-hours settings: a paediatric after-hours clinic, a tertiary paediatric hospital emergency department and a secondary general hospital emergency department. The patients' age, weight, sex and allergy to antibiotics were recorded as baseline characteristics. The physicians' antibiotic choice, dose and duration, and the use of investigations were recorded as outcome variables.
  
  
  RESULTS
  Amoxicillin was prescribed to 68% of patients at both the paediatric after-hours clinic and the paediatric hospital emergency department, compared with 53% of patients at the general hospital emergency department (P<0.01). The mean dose of amoxicillin prescribed at the paediatric after-hours clinic and the paediatric hospital emergency department were similar (43.4±9.7 mg/kg per day and 42.4±14.3 mg/kg per day, respectively) and higher than that prescribed at the general hospital emergency department (38.6±8.8 mg/kg per day, P<0.01). The paediatric after-hours clinic used investigations less often than did emergency departments (0.5% of cases compared with 9% and 20%, P<0.01).
  
  
  CONCLUSIONS
  The paediatric after-hours clinic provided a high level of adherence to a clinical practice guideline and had a low utilization of resource intensive investigations.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Toronto;
authors.forename: Jonathon L
authors.initials: JL
authors.lastname: Maguire
authors.forename: Jane
authors.initials: J
authors.lastname: Healey
authors.forename: Hartley
authors.initials: H
authors.lastname: Garfield
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin