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【medical-news】急性中耳炎：基层和指南对着干？
Primary Care Practice for Acute Otitis Media May Differ From Guidelines
August 10, 2007 — Primary care practice patterns for acute otitis media (AOM) differ considerably from 2004 guideline recommendations, according to the results of a study reported in the August issue of Pediatrics. Most physicians accept the concept of an option for observation but seldom use it; antibiotics prescribed for AOM vary widely from those recommended in the guidelines, and the degree of variance has increased since 2004.
"In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) released a clinical practice guideline on the management of acute otitis media that included endorsement of an observation option for selected cases and recommendations of specific antibiotics," write Louis Vernacchio, MD, MSc, from Boston University in Massachusetts, and colleagues. "We sought to describe primary care physicians' current management of acute otitis media to compare it with the guideline's recommendations and describe trends since 2004."
The investigators sent a mail survey to members of the Slone Center Office-Based Research Network, a national practice-based pediatric research network, from March through June 2006. The response rate was 62.7% (299/477).
The option to observe AOM without immediate antibiotic treatment was considered reasonable by 88.0% of physicians in 2004 and 83.3% in 2006. However, physicians surveyed in 2006 reported using the option of observation during the previous 3 months in a median of only 15% of AOM cases. Physicians reported that the most frequent barriers to using the observation option were parental reluctance not to have antibiotics prescribed for their children (83.5%) and the cost and difficulty of following up children who fail to improve (30.9%).
For each of 4 common clinical scenarios of AOM, agreement with antibiotic recommendations of the 2004 guidelines decreased from 2004 to 2006. Agreement in 2006 for each of these AOM scenarios was 57.2% for using high-dose amoxicillin for nonsevere symptoms, 12.7% for using high-dose amoxicillin-clavulanate for severe symptoms, 42.8% for using high-dose amoxicillin-clavulanate for cases refractory to amoxicillin, and 16.7% for using intramuscular ceftriaxone for cases refractory to amoxicillin-clavulanate.
"Most primary care physicians accept the concept of an observation option for acute otitis media but use it only occasionally," the authors write. "Antibiotics prescribed for acute otitis media differ markedly from the guideline's recommendations, and the difference has increased since 2004."
Limitations of the study include lack of generalizability to physicians not involved in a research network, and possible response bias or other unmeasured bias.
"In the end, even the best evidence-based recommendations serve to improve care only if the clinicians charged with their implementation find them both scientifically convincing and clinically practical," the authors conclude. "In the case of the 2004 AAP/AAFP AOM guideline, the experts still face the substantial challenge of convincing pediatric practitioners that the recommendations represent the best interpretation of the data and of assisting those practitioners in overcoming barriers to their implementation."
The authors have disclosed no relevant financial relationships. Primary Care Practice for Acute Otitis Media May Differ From Guidelines
急性中耳炎初级医疗实际可能与指南有异
August 10, 2007 — Primary care practice patterns for acute otitis media (AOM) differ considerably from 2004 guideline recommendations, according to the results of a study reported in the August issue of Pediatrics. Most physicians accept the concept of an option for observation but seldom use it; antibiotics prescribed for AOM vary widely from those recommended in the guidelines, and the degree of variance has increased since 2004.
2007年8月10日，根据本月出版的《儿科》的一项研究报告，急性中耳炎的初级医疗实际情况与2004年的推荐标准相差较大。多数医师认可观察理念但绝少采用；针对急性中耳炎的抗生素处方与这些推荐标准差别较大，且其程度自2004年来逐渐增大。
"In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) released a clinical practice guideline on the management of acute otitis media that included endorsement of an observation option for selected cases and recommendations of specific antibiotics," write Louis Vernacchio, MD, MSc, from Boston University in Massachusetts, and colleagues. "We sought to describe primary care physicians' current management of acute otitis media to compare it with the guideline's recommendations and describe trends since 2004."
“在2004年，美国儿科协会和美国家庭医师协会发布了关于控制急性中耳炎的临床实践指南，其中包括对经过挑选的病例进行观察，及推荐使用的抗生素种类”，麻州波士顿大学的路易斯教授和他的同事们写道，“我们通过探索以描述初级保健医师当前对急性中耳炎的控制方法，再将其与推荐指标相比较，并描绘其自2004年以来的趋势。”
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作者:admin@医学,生命科学 2011-09-07 05:11
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