Release: Embargoed until September 24, 2000 Contact: Jennifer Felsher202-371-4517 (9/23-27)703-519-1549[email protected]
STUDY QUESTIONS WHETHER AHCPR EVIDENCE-BASED PRACTICE GUIDELINES ARE REACHING INTENDED AUDIENCE
The Agency for Health Care Policy and Research and medical societies joined together to outline the best procedures to treat ear infections. A new study found that pediatricians and ear, nose, and throat specialists fail to comply with new recommendations.
Washington, D.C. -- In 1994 the Agency for Health Care Policy and Research developed and published clinical practice guidelines for children aged one to three with otitis media with effusion (ear infection). Although this effort was widely applauded by medical societies and academicians, a new study suggests that the guidelines have had little effect on the actual practice patterns of pediatricians and otolaryngologist--head and neck surgeons.
The authors of the study, "Practice Patterns Versus Practice Guidelines in Pediatric Otitis Media," are Michael G. Stewart, MD, MPH, Spiros Manolidis, MD, Rhonda Wynn, MD and Marilyn Bautista, MPH, are all from Baylor College of Medicine in Houston, TX. On Wednesday, September 27, Dr. Stewart will present the study's findings at the Annual Meeting of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation, being held September 24-27, 2000, at the Washington, DC Convention Center.
Much time and effort is expended to create peer-reviewed clinical guidelines for various common disorders. Pediatric otitis media with effusion is one of these common disorders. It is unclear; however, whether or not physicians, both generalists and specialists, actually change the way they practice in order to adhere to the guidelines.
This study hypothesized that less than 75 percent of physicians would be knowledgeable about the published guidelines. Additionally, the authors supposed that specialist physicians would have a better knowledge than generalists. Surprisingly, the results indicate that there is little difference between a general physician (in this case, a pediatrician) and a specialist (an otolaryngologist or pediatric otolaryngologist) in knowledge of the guidelines.
Methodology: Three distinct groups were queried, generalists, specialists, and subspecialists. A written survey was sent randomly to 1167 physicians who practice in the US selected from the membership rosters of the American Academy of Otolaryngology -- Head and Neck Surgery (representing the specialist segment), the American Academy of Pediatrics (representing the generalist segment), and all members of American Society of Pediatric Otolaryngology (representing the subspecialist group). Residents and faculty practicing outside the US were excluded.
A demographic quiz was included as well as a six question survey addressing specific issues presented in the 12 page "Quick Reference Guide for Physicians" format of the clinical practice guidelines, "Otitis Media with Effusion in Young Children," published in 1994 by the Agency for Health Care and Policy Research (now known as Agency for Health Research and Quality). The questionnaire was graded on a scale of zero to six, with higher scores indicating agreement with the guidelines. An analysis of the data was performed in three ways: chi-squared, Mann-Whitney U test, and a frequency analysis.
Results: The overall response rate was 48 percent. The average age of the respondent was 45 years old with an average of 13 years in practice.
There were no statistically significant differences in total score between pediatricians and otolaryngologists, or between pediatricians and pediatric otolaryngologists. Younger physicians were more aware of the guidelines, and physicians in an academic environment had significantly higher total scores.
Practice patterns showed that pediatricians were more likely to treat a new ear infection with a six-week observation period than an otolaryngologist or a pediatric otolaryngologist. However, most specialists responded correctly that antibiotics would hasten resolution of ear infections. The question generalists most frequently answered incorrectly was that nasal steroids and decongestants would hasten resolution.
Conclusions: The results indicate that the practice patterns of pediatricians, otolaryngologists, and pediatric otolaryngologists differ, in some cases significantly, from the recommendations of an evidence-based practice guideline. Overall, physicians were more aware of the guidelines associated with items related to diagnostic testing and early treatment. Although it is unclear from this study whether or not these discrepancies were due to poor dissemination of the practice guidelines or just lack of knowledge, the data clearly indicate problems in otolaryngology and pediatrics with familiarity with government-sponsored practice guidelines for otitis media.
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