Vernacchio Louis, Vezina Richard M, Mitchell Allen A
Slone Epidemiology Center at Boston University, Boston, MA 02215, USA.
Pediatr Infect Dis J. 2006 May;25(5):385-9. doi: 10.1097/01.inf.0000214961.90326.d0.
To identify primary care physicians' familiarity with the 2004 acute otitis media (AOM) clinical practice guideline and to compare their practices with its recommendations.
Mail survey October through December 2004 to all active physician members of the Slone Center Office-based Research Network, a national, practice-based, pediatric research network.
The response rate was 276 of 469 (58.8%). Overall, 90.5% had read the guideline or summaries of it. Pneumatic otoscopy was always used by 16.2%, used half the time or more by 23.1%, used less than half the time by 34.6% and never used by 26.2%. Observation is considered a reasonable option for some AOM cases by 88.0% and, over the previous 3 months, these physicians used observation a median of 10% of the time (25th and 75th percentiles, 5% and 25%, respectively). In terms of concern that the observation option may increase AOM complications, 75.6% were not at all or only slightly concerned; 24.4% were moderately or very concerned. In general, these physicians have altered their antibiotic prescribing practices for AOM towards the guideline's recommendations since its publication. However, antibiotic choices deviated most widely from the guideline in cases of AOM with severe illness, where only 17.9% follow the recommendation for high-dose amoxicillin-clavulanate, and in cases of children who fail treatment with amoxicillin-clavulanate, where only 27.7% favor the recommended intramuscular ceftriaxone.
Most physicians in this survey are familiar with the AOM guideline, but many do not follow its diagnostic and antibiotic recommendations. Observation for selected cases is acceptable to most of these physicians and is currently used in a small proportion of cases.
确定基层医疗医生对2004年急性中耳炎（AOM）临床实践指南的熟悉程度，并将他们的诊疗行为与其建议进行比较。
2004年10月至12月对斯隆中心门诊研究网络的所有在职医生成员进行邮件调查，该网络是一个全国性的、基于实践的儿科研究网络。
469名医生中有276名回复（58.8%）。总体而言，90.5%的医生阅读过该指南或其摘要。16.2%的医生总是使用鼓气耳镜检查，23.1%的医生使用时间占一半或更多，34.6%的医生使用时间不到一半，26.2%的医生从未使用过。88.0%的医生认为对某些AOM病例进行观察是一种合理的选择，在过去3个月里，这些医生使用观察的时间中位数为10%（第25和第75百分位数分别为5%和25%）。对于观察选项可能增加AOM并发症的担忧，75.6%的医生完全不担心或只是略有担心；24.4%的医生中度或非常担心。总体而言，自该指南发布以来，这些医生针对AOM的抗生素处方行为已朝着指南建议的方向改变。然而，在重症AOM病例中，抗生素选择与指南偏差最大，只有17.9%的医生遵循高剂量阿莫西林-克拉维酸的建议；在阿莫西林-克拉维酸治疗失败的儿童病例中，只有27.7%的医生倾向于推荐的肌内注射头孢曲松。
本次调查中的大多数医生熟悉AOM指南，但许多医生并未遵循其诊断和抗生素建议。大多数医生接受对选定病例进行观察，目前该方法仅在一小部分病例中使用。
