title: The use of practice guidelines in the management of pediatric cases of Acute Otitis Media in Amman, Jordan.
abstract: OBJECTIVE
  The widespread emergence of antimicrobial resistance has led many healthcare institutions to adopt more conservative antibiotic prescription practice guidelines for the treatment of acute otitis media (AOM). Little is known about the awareness and use of such guidelines by physicians in Jordan. Our aim was to pilot an anonymous survey instrument that would assess AOM treatment trends as well as awareness of and adherence to practice guidelines in Amman. By qualitatively assessing the management of AOM we could illuminate possible disparities in treatment trends, evaluate variability in practice guideline adherence, and help focus efforts of future educational programs that pertain to pediatric AOM management.
  
  
  METHODS
  A total of 71 practicing physicians were anonymously surveyed in Amman, Jordan. The survey assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted.
  
  
  RESULTS
  In total, participants answered 61.2% of the questions correctly. It was found that trainees would prescribe more appropriate antibiotics relative to attending physicians (p = 0.008). It was found that medical physicians followed guidelines more appropriately relative to ENT surgeons (64.2% of questions answered correctly vs. 58.1% of questions answered correctly; p = 0.015) and that physicians who report adhering to guidelines all/most of the time followed guidelines more appropriately relative to those who report adhering only sometimes or never (64.0% of questions answered correctly vs. 58.0% of questions answered correctly; p = 0.011). Also, cases that dealt with children were the most difficult for participants to diagnose as compared with cases that dealt with adults.
  
  
  CONCLUSIONS
  We conducted the first known qualitative analysis of otitis media practices in Amman and found numerous shortcomings in AOM guideline familiarity. Awareness of practice guidelines can lead to more appropriate AOM management, but there is variability between groups in guideline familiarity and utilization. Interventions that promote more conservative antibiotic prescriptions could be targeted towards groups that prescribe antibiotics less appropriately relative to their colleagues e.g. attending physicians and ENT surgeons. Interventions could also target physicians who manage pediatric AOM cases as participants had the most difficulty in properly diagnosing cases that involved children and infants.
authors.affiliation: Otolaryngology, Department of Special Surgeries, Faculty of Medicine, University of Jordan, Amman, Jordan.
authors.forename: Lubna
authors.initials: L
authors.lastname: Khreesha
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bacharouch
authors.affiliation: Department of Pediatrics and Communicable Diseases, Associate Professor of Pediatric Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: rab@med.umich.edu.
authors.forename: R Alexander
authors.initials: RA
authors.lastname: Blackwood
authors.affiliation: University of Jordan, Amman, Jordan.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alkhoujah
authors.affiliation: University of Pittsburgh Department of Otolaryngology, Pittsburgh, PA, USA.
authors.forename: Mohamad R
authors.initials: MR
authors.lastname: Issa
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007597:Jordan; D008297:Male; D010033:Otitis Media / Q000628:therapy*; D010820:Physicians; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute Otitis Media; Amman Jordan; Practice guideline adherence