Marom Tal, Bobrow Mathan, Eviatar Ephraim, Oron Yahav, Ovnat Tamir Sharon
Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler Faculty of Medicine, 70300 Zerifin, Israel.
Faculty of Medicine, Tel Aviv University Sackler School of Medicine, 69978 Tel Aviv, Israel.
Int J Pediatr Otorhinolaryngol. 2017 Apr;95:63-68. doi: 10.1016/j.ijporl.2017.02.003. Epub 2017 Feb 7.
The recent Israeli acute otitis media (AOM) guidelines, drafted mainly by pediatricians and family physicians in 2013, addressed diagnostic and therapeutic issues, in order to reduce over-diagnosis and treatment. These guidelines are considered as the 'standard of care' for AOM management. While the adherence rate of pediatricians to previous Israeli AOM guidelines (2004) was reported to be high (>85%), the compliance of otolaryngologists has not been studied.
An anonymous 19-item questionnaire was circulated among practicing Israeli otolaryngologists (residents [n = 93], specialists [n = 283]). All the items were scored according to the number of correct answers in line with the guidelines, and summed on a 0-100 scale.
Response rate was 34% (n = 127). Overall, scores of correct answers of residents (n = 48, 52% of all residents) and specialists (n = 79, 28% of all specialists) were similar, and showed comparable moderate adherence to both guidelines: 55.7 vs 58.3 (p = 0.26). Residents were more likely to adhere to the U.S. guidelines, when compared to specialists (score difference 6.1 vs 2.8, p = 0.008). Responders preferred the microscope for diagnosis (48%), over the recommended (pneumatic) otoscope (62%) (p = 0.05), and were more likely to start antibiotic therapy (62%), rather than the 'watchful waiting' (38%) (p = 0.03). Concerning antibiotic treatment, 50% of otolaryngologists prescribed amoxicillin as recommended, at 60-80 mg/kg/d.
The moderate adherence rate suggests that the guidelines were partially adopted by otolaryngologists, who use different instrumentation than recommended, and treat more severe/complicated cases. Over-treatment with antibiotics and inaccurate dosing regimens are still common. Better implementation of the AOM guidelines among otolaryngologists should be performed in designated training platforms.
近期由儿科医生和家庭医生于2013年起草的以色列急性中耳炎（AOM）指南，涉及诊断和治疗问题，目的是减少过度诊断和治疗。这些指南被视为AOM管理的“护理标准”。虽然据报道儿科医生对先前以色列AOM指南（2004年）的遵循率很高（>85%），但尚未对耳鼻喉科医生的依从性进行研究。
一份包含19项内容的匿名问卷在以色列执业耳鼻喉科医生（住院医生[n = 93]、专科医生[n = 283]）中分发。所有项目根据符合指南的正确答案数量进行评分，并在0 - 100分的量表上进行汇总。
回复率为34%（n = 127）。总体而言，住院医生（n = 48，占所有住院医生的52%）和专科医生（n = 79，占所有专科医生的28%）的正确答案得分相似，对两个指南的遵循程度适中：55.7分对58.3分（p = 0.26）。与专科医生相比，住院医生更倾向于遵循美国指南（得分差异为6.1分对2.8分，p = 0.008）。受访者在诊断时更倾向于使用显微镜（48%），而非推荐的（气动）耳镜（62%）（p = 0.05），并且更倾向于开始抗生素治疗（62%），而非“观察等待”（38%）（p = 0.03）。关于抗生素治疗，50%的耳鼻喉科医生按照推荐剂量60 - 80mg/kg/d开具阿莫西林。
适中的遵循率表明耳鼻喉科医生部分采纳了指南，但他们使用的器械与推荐的不同，且治疗的是更严重/复杂的病例。抗生素过度治疗和不准确的给药方案仍然很常见。应在指定的培训平台上更好地在耳鼻喉科医生中实施AOM指南。
