INTRODUCTION: Otitis media remains one of the most common reasons for childhood primary health care presentations. Indigenous children are at the highest risk, but there are scarce data on how they are managed.
OBJECTIVE: We sought to determine how Australian primary health care medical practitioners diagnose and manage otitis media in Indigenous and non-Indigenous children.
METHODS: We contacted all of Australia's Aboriginal Medical Services by using the national government's register to identify their medical practitioners. We mailed a pilot 5-page clinical vignette questionnaire instrument to these primary health care practitioners (N = 257). Responses for Indigenous children were compared with those for non-Indigenous children.
RESULTS: Questionnaires were returned from 40.9% of medical practitioners (105 of 257) and 64.8% (57 of 88) of the nation's Aboriginal Medical Services. When examining children, practitioners used otoscopy (99.0% often/always) but not pneumatic otoscopy (67.0% never) or tympanometry (55.8% never). When practitioners diagnosed acute otitis media, they were more likely to use antibiotics (104 of 113 [92.0%]) when the child was Indigenous versus non-Indigenous (53 of 112 [47.3%]) (odds ratio: 12.9 [95% confidence interval: 5.9–27.9]). Amoxicillin was the most common antibiotic used (309 of 356 [86.8%]). The major factors that determined the practitioners' otitis media antibiotic use were Indigenous status (65.7%), wet perforations (63.7%), bulging tympanic membranes (58.3%), and fever (56.3%). The major factors for choosing no antibiotics were dry perforations (35.3%) and a well child (24.8%). Most practitioners were aware of the national guidelines (97.1%) but not the guidelines for Indigenous children (47.0%).
CONCLUSIONS: Aboriginal Medical Service practitioners rely on otoscopy alone to diagnose otitis media and are more likely to use antibiotics for Indigenous children despite not knowing the guidelines.
Submitted by Hasantha Gunasekera
- Copyright © 2008 by the American Academy of Pediatrics