To identify physician and visit characteristics affecting adherence to guidelines recommending delayed antibiotic therapy for acute otitis media (AOM).Methods:
We used physician visit data from an Israeli health maintenance organization to identify children ages 0–15 diagnosed with AOM. We defined early antibiotic treatment as purchase, within 3 days of diagnosis, of antibiotics prescribed by the diagnosing physician. We considered the effect of physician specialty (paediatrician, otolaryngologist, and family physician), day of the week, setting (urgent care/clinic) and clinic location (peripheral/central) on the rate of early treatment.Results:
Proportion of cases receiving early treatment dropped from 2002 to 2009 in cases treated by otolaryngologists (47–36%) and paediatricians (46–42%) and increased in cases treated by family physicians (43–50%). Treatment rate was higher in cases treated on weekends than on weekdays (48% vs. 44%), in urgent care as compared to clinic settings (51% vs. 44%), and in children living in peripheral as compared to central areas (52% vs. 38%).Conclusions:
Successful implementation of delayed treatment of otitis media guidelines requires addressing factors associated with increased early treatment rates.