Rinehart Deborah J, Gilbert Aiden, O'Leary Sonja, Katz Sophie E, Frost Holly M
Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, Denver, CO, USA.
Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Jan 6;5(1):e3. doi: 10.1017/ash.2024.469. eCollection 2025.
This qualitative study aimed to understand facilitators and barriers to implementation of interventions to improve guideline-concordant antibiotic duration prescribing for pediatric acute otitis media (AOM).
Clinicians and clinic administrators participated in semi-structured qualitative interviews, and parents of children 2 years of age or older with a recent diagnosis of AOM participated in focus groups. The Practical Robust Implementation and Sustainability Model (PRISM) guided the study. Interviews were analyzed using the Rapid Assessment Process.
Denver Health and Hospital Authority (Denver, CO) led the study. Recruitment occurred at Vanderbilt University Medical Center (Nashville, TN) and Washington University in St. Louis Medical Center (St. Louis, MO).
Purposeful sampling was used to recruit clinicians and administrators for qualitative interviews. Convenience sampling was used to recruit parents for focus groups.
Thirty-one participants (15 clinicians, 4 administrators, and 12 parents) engaged in interviews and focus groups. Factors influencing antibiotic prescribing included patient history, years of practice, familiarity with the patient, concerns with patient medication adherence, and practice type. Clinicians endorsed electronic health record modifications and clinician prescribing feedback as methods to improve patient care and reduce the durations of prescribed antibiotics. Suggestions for intervention optimization and education needs were also obtained.
Findings suggest that clinicians and administrators support reducing prescribed antibiotic durations for AOM and are receptive to the proposed interventions. More education is needed to increase parent awareness about antibiotic stewardship and AOM treatment options.
RELAX: Reducing Length of Antibiotics for Children with Ear Infections (RELAX), NCT05608993, https://clinicaltrials.gov/study/NCT05608993.
本定性研究旨在了解实施干预措施以改善小儿急性中耳炎（AOM）抗生素疗程处方遵循指南情况的促进因素和障碍。
临床医生和诊所管理人员参与了半结构化定性访谈，2岁及以上近期诊断为AOM的儿童家长参与了焦点小组讨论。实用稳健实施与可持续性模型（PRISM）指导了本研究。访谈采用快速评估流程进行分析。
丹佛健康与医院管理局（科罗拉多州丹佛）主导了本研究。招募工作在范德堡大学医学中心（田纳西州纳什维尔）和圣路易斯华盛顿大学医学中心（密苏里州圣路易斯）进行。
采用目的抽样法招募临床医生和管理人员进行定性访谈。采用便利抽样法招募家长参与焦点小组讨论。
31名参与者（15名临床医生、4名管理人员和12名家长）参与了访谈和焦点小组讨论。影响抗生素处方的因素包括患者病史、从业年限、对患者的熟悉程度、对患者用药依从性的担忧以及执业类型。临床医生认可通过电子健康记录修改和临床医生处方反馈来改善患者护理并缩短抗生素处方疗程。还获得了干预优化和教育需求方面的建议。
研究结果表明，临床医生和管理人员支持缩短AOM的抗生素处方疗程，并愿意接受所提议的干预措施。需要开展更多教育以提高家长对抗生素管理和AOM治疗方案的认识。
RELAX：减少耳部感染儿童抗生素使用时长（RELAX），NCT05608993，https://clinicaltrials.gov/study/NCT05608993 。
