title: Results of a national study on the awareness of and attitudes toward acute otitis media (AOM) among clinicians and the estimated direct healthcare costs in Turkey (TR-AOM Study).
abstract: OBJECTIVE
  Acute otitis media (AOM) is one of the most frequent diagnoses and reasons for prescribing antibiotics in children. The aims of this prospective study were the following: (1) to assess the continuing education of physicians and the sources of information about AOM; (2) to assess the current knowledge of and attitudes toward AOM as well as the compliance with AOM guidelines; (3) to evaluate opinions about vaccines against AOM; and (4) to estimate the potential costs of AOM on the healthcare system in Turkey.
  
  
  METHODS
  This is a web-based cross-sectional survey of a national convenience sample of 600 physicians in Turkey (325 pediatricians (PEDs), 214 family physicians/general practitioners (FP&GPs) and 61 otolaryngologists (ENTs)).
  
  
  RESULTS
  Approximately 38.6% of participants (39.4% of PEDs, 44.3% of GP&FPs and 14.7% of ENTs) stated that pneumatic otoscopy is essential for AOM diagnosis. Regarding the most common etiological agents of AOM in children, 54.2% of PEDs, 51.4% of FP&GPs and 57.4% of ENTs stated that the most common causative agents of AOM are Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Nearly 76% of participants indicated they use direct antibiotic therapy when they diagnose AOM in certain situations. The first-line choice of antibiotic therapy is amoxicillin clavulanate, and 67% of participants prefer to use antibiotic therapy for 7-10 days. Approximately 31% of all participants stated that "viruses" are the main cause of AOM; however, 62% of these participants reported using antibiotic therapy. In comparison, 32% participants from private clinics prefer to treat AOM primarily with observation, a rate that is significantly higher than that of other clinical settings. Physicians who prefer to use observation strategy also prefer the combination of paracetamol and NSAIDs. Approximately 41% of participants have undergone postgraduate medical education on the topic of AOM. In total, 73% of all participant physicians believe that otitis media is a vaccine-preventable disease. With the information from all of the participants, the calculated mean cost per case of AOM is 28 ± 4 USD. In Turkey, the estimated incidence of AOM is 24,000-33,000 cases per 10,000 children <5 years of age (1,820,000-2,100,000 cases per year), and the estimated total cost of AOM is 61,152,000 USD (not including acute otitis media-related complications and otitis media-related hospitalizations).
  
  
  CONCLUSIONS
  The medical and economic burden of AOM to the health economics in Turkey is considerable. Specific educational programs and evidence-based national guidelines concerning AOM should be implemented. Improving diagnostic accuracy with education will lead to improved management, judicious use of antibiotics, decreased antibiotic resistance, and potential economic benefits. A more prudent use of antibiotics would also lower the economic burden of this disease. Vaccination seems to be promising for the prevention of AOM.
authors: Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey. timboothtr@yahoo.com
authors: Ener Cagri
authors: EC
authors: Dinleyici
authors: Fatih
authors: F
authors: Yuksel
authors: Zeynel Abidin
authors: ZA
authors: Yargic
authors: Murat
authors: M
authors: Unalacak
authors: Ilhami
authors: I
authors: Unluoglu
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001290:Attitude; D002648:Child; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010033:Otitis Media / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014421:Turkey
chemical_list: D000900:Anti-Bacterial Agents