Abstract
BackgroundOptimal 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.AimTo 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 & settingQualitative study conducted alongside a cluster randomised controlled trial (cRCT), the PIMPOM study, in the Netherlands.MethodTwelve 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.ResultsGPs 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.ConclusionA 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.
Highlights
Ear pain is a key symptom of childhood AOM1 and is central to children’s and parents’ experience of the illness.[2,3] Clinical practice guidelines emphasise the importance of analgesics in childhood acute otitis media (AOM) management.[1,4] Current evidence, indicates that these recommendations are not routinely adopted in day-to-day practice since analgesics are often neither prescribed routinely nor explicitly recommended in this condition.[5,6,7]Insights into the underlying mechanisms of this routine practice, including GPs’ perceptions on and experiences with analgesia in childhood AOM, are currently lacking
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
Summary
Ear pain is a key symptom of childhood AOM1 and is central to children’s and parents’ experience of the illness.[2,3] Clinical practice guidelines emphasise the importance of analgesics in childhood AOM management.[1,4] Current evidence, indicates that these recommendations are not routinely adopted in day-to-day practice since analgesics are often neither prescribed routinely nor explicitly recommended in this condition.[5,6,7]Insights into the underlying mechanisms of this routine practice, including GPs’ perceptions on and experiences with analgesia in childhood AOM, are currently lacking. It is known that parents feel unhappy if symptoms of concern, such as ear pain or fever, are not properly addressed.[8] Yet, parents often consider analgesia as stand-alone treatment insufficient to manage AOM adequately and feel this option is inferior to antibiotic treatment.[7,9] GPs, in turn, often resort to antibiotics in order to do something in situations of diagnostic uncertainty or perceived parental pressure.[8] This practice in turn reinforces parents in their perception that antibiotics are needed when their child suffers from AOM.[9]. 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
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