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      Pain management in acute otitis media: a qualitative study exploring GPs’ views and expectations parallel to a trial of an educational intervention

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          Abstract

          Background

          Optimal pain management is accepted as the cornerstone of acute otitis media (AOM) management, but analgesics are neither prescribed routinely nor explicitly recommended in day-to-day practice.

          Aim

          To explore GPs views on and expectations regarding pain management in children with AOM, and how a multifaceted educational intervention aimed at optimising pain management shapes these perceptions.

          Design & setting

          Qualitative study conducted alongside a cluster randomised controlled trial (cRCT), the PIMPOM study, in the Netherlands.

          Method

          Twelve GPs were purposefully sampled from primary care centres allocated to the intervention group and were interviewed, using semi-structured, audio-recorded interviews. The intervention comprised a blended GP educational programme (internet-based and face-to-face training) aimed at discussing pain management proactively with parents using a parent information leaflet, and prescribing paracetamol and ibuprofen according to current guidelines. Interviews were transcribed verbatim and analysed thematically by a multidisciplinary team.

          Results

          GPs considered AOM a very painful condition. Initially, GPs felt unable to offer adequate treatment for AOM-related ear pain. The intervention provided tools, such as knowledge, communication skills, and an information leaflet, which reduced their feelings of helplessness and empowered them to manage childhood AOM more adequately. GPs indicated that the intervention led to a shift in focus from treating the infection with antibiotics to treating symptoms with analgesics. There was a general lack of knowledge about the possibility of prescribing ibuprofen to children. GPs expressed mixed views on prescribing this drug to children.

          Conclusion

          A primary-care based multifaceted educational intervention aimed at optimising pain management in childhood AOM offered GPs tools to optimise management of this condition and changed GPs perceptions, namely from treating the infection with antibiotics to treating symptoms.

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          Most cited references11

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          A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care

          Patricia Lucas, Christie Cabral, Alastair D Hay … (2015)
          Abstract Objectives. To investigate the views of parents, clinicians, and children pertaining to prescribing decisions for acute childhood infection in primary care. Methods. A systematic review of qualitative studies. Meta-ethnographic methods were used, with data drawn from the primary studies in an interpretive analysis. Results. A total of 15 studies met the inclusion criteria. The literature was dominated by concerns about antibiotic over-prescription. Children's views were not reported. Clinicians prescribed antibiotics when they felt pressured by parents or others (e.g. employers) to do so, when they believed there was a clear clinical indication, but also when they felt uncertain of clinical or social outcomes they prescribed “just in case”. Parents wanted antibiotics when they felt they would improve the current illness, and when they felt pressure from daycare providers or employers. Clinicians avoided antibiotics when they were concerned about adverse reactions or drug resistance, when certain they were not indicated, and when there was no perceived pressure from parents. Parents also wished to avoid adverse effects of antibiotics, and did not want antibiotics when they would not relieve current symptoms. Some parents preferred to avoid medication altogether. Within paediatric consultations, parents sought a medical evaluation and decision. Primary care clinicians want satisfied parents and short consultations. Conclusions. Antibiotic prescriptions for childhood infections in primary care often result from “just in case” prescribing. These findings suggest that interventions which reduce clinician uncertainty regarding social or clinical outcomes and provide strategies to meet parents’ needs within a short consultation are most likely to reduce antibiotic prescribing.
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            Acute otitis media in young children - what do parents say?

            Colin Barber, Susanne Ille, Anne Vergison … (2014)
            The Ear infections Attitudes Research study investigated parental attitudes and awareness towards acute otitis media (AOM) and evaluated the burden of AOM for affected children, their families, and parental work capabilities.
            Article 0 comments Cited 14 times – based on 0 reviews     Review now
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              Parents’ beliefs and knowledge about the management of acute otitis media: a qualitative study

              Malene Plejdrup Hansen, Janine Howlett, Chris Del Mar … (2015)
              Background Acute otitis media is a common reason for antibiotic prescribing, despite strong evidence that antibiotics provide minimal benefit. Studies have demonstrated that patients’ (or parents’) expectations of antibiotics often influence general practitioners’ (GPs) decision to prescribe antibiotics, but few have explored parents’ expectations of the management of infections in children, or which factors influence the development of these expectations. This study aimed to explore parents’ knowledge and beliefs about the management of acute otitis media in children. Methods Individual semi-structured interviews were conducted with 15 parents of children who had recently presented to their GP with acute otitis media. Parents were recruited at childcare centres or playgroups in Brisbane, Australia. Results Many parents did not have an accurate understanding of what causes acute otitis media. GPs were primarily consulted for the management of symptoms such as pain and fever. Others specifically wanted reassurance or were concerned about hearing loss. Most parents assumed that antibiotics were the best treatment option. Parents’ perceptions about the best treatment were mainly based on their previous experience and the advice of the GP. Pain relief medications, such as paracetamol and non-steroidal anti-inflammatory drugs, were not considered by parents to be sufficient treatment on their own. Conclusion There is discrepancy between parents’ beliefs and expectations of management of acute otitis media and the evidence-based recommendations. This study provides insights into parents’ expectations of management of acute otitis media, which may help inform clinicians about perceptions and misperceptions that may be valuable to elicit and discuss.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BJGP Open
                Journal ID (iso-abbrev): BJGP Open
                Journal ID (publisher-id): bjgpoa
                Journal ID (hwp): bjgpoa
                Title: BJGP Open
                Publisher: Royal College of General Practitioners
                ISSN (Electronic): 2398-3795
                Publication date (Electronic): 31 October 2018
                Publication date Collection: December 2018
                Volume: 2
                Issue: 4
                Electronic Location Identifier: bjgpopen18X101620
                Affiliations
                [1 ]deptGP Trainee and PhD Candidate, Julius Center for Health Sciences and Primary Care , University Medical Centre Utrecht , Utrecht, The Netherlands
                [2 ]deptGP Trainee, Julius Center for Health Sciences and Primary Care , University Medical Centre Utrecht , Utrecht, The Netherlands
                [3 ]deptGP and Assistant Professor, Julius Center for Health Sciences and Primary Care , University Medical Centre Utrecht , Utrecht, The Netherlands
                [4 ]deptEar, Nose and Throat Surgeon, Professor of Paediatric Otorhinolaryngology, and National Institute for Health Research Professor, evidENT Ear Institute , University College London , London, UK
                [5 ]deptEar, Nose and Throat Surgeon, Professor of Paediatric Otorhinolaryngology, and National Institute for Health Research Professor, Julius Center for Health Sciences and Primary Care , University Medical Centre Utrecht , Utrecht, The Netherlands
                [6 ]deptAssistant Professor of Education and Evidence-based Medicine in General Practice, Julius Center for Health Sciences and Primary Care , University Medical Centre Utrecht , Utrecht, The Netherlands
                [7 ]deptGP and Professor of Primary Care, Julius Center for Health Sciences and Primary Care , University Medical Centre Utrecht , Utrecht, The Netherlands
                [8 ]deptPrimary Health Care Sociologist and Postdoctoral Researcher, Department of Primary Care and Interdisciplinary Care , Antwerp University , Wilrijk, Belgium
                Author notes
                Article
                Publisher ID: 01620
                DOI: 10.3399/bjgpopen18X101620
                PMC ID: 6348326
                PubMed ID: 30723805
                SO-VID: 24f6ac6a-ccda-42dd-9075-9293998ec963
                Copyright © Copyright © 2018, The Authors
                License:

                This article is Open Access: CC BY-NC 4.0 license ( https://creativecommons.org/licenses/by-nc/4.0/)

                History
                Date received : 18 June 2018
                Date accepted : 22 June 2018
                Categories
                Subject: Research

                Keywords: acute otitis media,otitis media,primary health care,pain management,qualitative research
                Data availability:
                Keywords: acute otitis media, otitis media, primary health care, pain management, qualitative research

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