Western Sydney University, Penrith, NSW.
Murrumbidgee Local Health District, Wagga Wagga, NSW.
Med J Aust. 2024 Mar 4;220(4):202-207. doi: 10.5694/mja2.52217. Epub 2024 Jan 24.
To explore the views of parents and carers regarding the management of acute otitis media in urban Aboriginal and Torres Strait Islander children who are at low risk of complications living in urban communities.
Qualitative study; semi-structured interviews and short telephone survey.
SETTING, PARTICIPANTS: Interviews: purposive sample of parents and carers of urban Aboriginal and Torres Strait Islander children (18 months - 16 years old) screened in Aboriginal medical services in Queensland, New South Wales, and Canberra for the WATCH study, a randomised controlled trial that compared immediate antibiotic therapy with watchful waiting for Aboriginal and Torres Strait Islander children with acute otitis media.
parents and carers recruited for the WATCH trial who had completed week two WATCH surveys.
We interviewed twenty-two parents and carers, including ten who had declined participation in or whose children were ineligible for the WATCH trial. Some interviewees preferred antibiotics for managing acute otitis media, others preferred watchful waiting, expressing concerns about side effects and reduced efficacy with overuse of antibiotics. Factors that influenced this preference included the severity, duration, and recurrence of infection, and knowledge about management gained during the trial and from personal and often multigenerational experience of ear disease. Participants highlighted the importance of shared decision making by parents and carers and their doctors. Parents and carers of 165 of 262 WATCH participants completed telephone surveys (63%); 81 were undecided about whether antibiotics should always be used for treating acute otitis media. Open-ended responses indicated that antibiotic use should be determined by clinical need, support for general practitioners' decisions, and the view that some general practitioners prescribed antibiotics too often.
Parents and carers are key partners in managing acute otitis media in urban Aboriginal and Torres Strait Islander children. Our findings support shared decision making informed by the experience of parents and carers, which could also lead to reduced antibiotic use for managing acute otitis media.
探讨在城市中居住、并发症风险低的澳裔和托雷斯海峡岛民的低龄儿童中，父母和照顾者对急性中耳炎管理的看法。
定性研究；半结构化访谈和简短的电话调查。
地点、参与者：访谈：在昆士兰州、新南威尔士州和堪培拉的原住民医疗服务机构中，对 WATCH 研究进行了筛查，该研究是一项随机对照试验，比较了急性中耳炎的澳裔和托雷斯海峡岛民儿童立即使用抗生素治疗与观察等待的效果，以此为目的，对城市澳裔和托雷斯海峡岛民儿童的父母和照顾者进行了有针对性的抽样调查。
为 WATCH 试验招募的父母和照顾者，他们已经完成了 WATCH 试验的第二周调查。
我们采访了 22 位父母和照顾者，其中包括 10 位拒绝参加或其孩子不符合 WATCH 试验条件的人。一些受访者更喜欢用抗生素来治疗急性中耳炎，而另一些则更喜欢观察等待，他们担心抗生素的副作用以及过度使用会降低疗效。影响这种偏好的因素包括感染的严重程度、持续时间和复发，以及在试验中和从个人及通常是多代人的耳疾经验中获得的管理知识。参与者强调了父母和照顾者与他们的医生共同决策的重要性。262 名 WATCH 参与者中有 165 名（63%）完成了电话调查；81 名对于抗生素是否应该始终用于治疗急性中耳炎仍未做出决定。开放性回答表明，抗生素的使用应根据临床需要、对全科医生决策的支持以及一些全科医生过于频繁开抗生素的观点来决定。
父母和照顾者是城市澳裔和托雷斯海峡岛民儿童急性中耳炎管理的关键合作伙伴。我们的研究结果支持了由父母和照顾者的经验提供信息的共同决策，这也可能导致抗生素治疗急性中耳炎的使用减少。
