Significance and Background of Healthcare Problem

The primary mandate of healthcare practitioners is to secure the wellbeing of communities. To fulfill this mandate, the practitioners need to engage in constant and unending research. The research enables the practitioners to identify interventions that are effective. These interventions are then integrated into practice with the goal of enhancing the outcomes of patient populations. Medical practitioners work tirelessly to incorporate the latest research findings into their work. However, despite the dedication that the practitioners have demonstrated, the needs of certain patient populations continue to go unmet. Children are among the populations that the practitioners need to focus their efforts on. In particular, children who have developed acute otitis media (AOM) require special attention. By channeling their energies and resources towards the treatment of these children, medical practitioners inch closer to fulfilling their mandate.

Description of Problem 

AOM has been selected for review because of the devastating impacts that it can have on the health and general wellbeing of children. Essentially, AOM is an infection that is caused by either bacteria or viruses. This infection is defined by an inflammation of the ear and mostly affects children (Young, 2016). Every year, millions of children make visits to healthcare facilities seeking treatment for AOM. There are a number of symptoms that a child needs to exhibit to be diagnosed with this condition. They include middle-ear effusion and inflammation in the middle ear, among others. What makes AOM a serious problem is the fact that it affects millions of children in the US and across the globe. Some of the risk factors that have been linked to this condition include age, family history, allergies and Immunodefiency, among others (Harmes et al., 2013).

Significance of Problem 

It is true that there are dozens of illnesses that could have been selected for discussion. This truth raises the question of why AOM was chosen. Its significance is the main rationale for the selection. As noted above, AOM affects millions of children in the US. According to Young (2016), children make as many as 30 million visits annually for treatment for this condition. Young adds that when they attain the age of 3, 85% of children will have suffered at least one episode of AOM. Another issue that makes AOM a significant problem is the fact that practitioners lack clarity regarding whether to treat it with antibiotics. As Sakulchit and Goldman (2017) observe, antibiotics have been used so routinely that patients have developed complications and AOM has become resistant to the antibiotics. Moreover, it is feared that antibiotics may present adverse effects for young children (Young, 2016). By exploring AOM, it is expected that greater clarity regarding the safety and effectiveness of such interventions as antibiotics will be gained.

Relevance to 2020 Goals 

To understand the significance of AOM, it is necessary to relate it to the Healthy People 2020 goals. These goals capture the aspirations that the American government hopes to attain as regards healthcare. Longer lives that are also of high quality, health equity, the establishment of environments that promote health and the encouragement of healthy behaviors are the main goals (CDC, 2015). The problem of AOM relates to all of these goals. For instance, as noted above, this illness is responsible for poor health outcomes among millions of American children. If AOM is not eradicated, the government will encounter hardships in achieving the goal of promoting the quality of the health of American children. Moreover, this illness also threatens to erode efforts to establish an environment that secures the wellbeing of the children. Overall, AOM could erode the efforts to attain the Healthy People 2020 goals.

Current Practice 

To gain a full understanding of AOM, it is helpful to examine the approaches and strategies that medical practitioners have adopted. Currently, antibiotics are the first line treatment for antibiotics. In fact, the antibiotics are administered to children who do not need them (Boatright, Holcomb & Replogle, 2015). Antibiotics continue to be used despite concerns that they are ineffective and fuel resistance. In his article, Michael Pichichero (2000) cautions that antibiotic resistance could precipitate a crisis and advises the medical community to explore other interventions for the treatment of AOM. It is encouraging that there are some practitioners that have responded to calls to move away from antibiotics. For example, Abbott (2016) and her colleagues present watchful waiting as a promising alternative.

Impact on Cultural Background 

Culture plays a vital role in shaping the delivery of healthcare services. Various scholars have sought to establish the interactions between cultural backgrounds and the treatment of AOM. Hansen (2015) and her colleagues are among these scholars. In their article, they note that such cultural issues as the beliefs of parents regarding the effectiveness of antibiotics and the immense faith that they place in medical practitioners influence the approaches that practitioners adopt. The scholars observed that most parents tend to trust physicians and believe that antibiotics are the most effective intervention (Hansen et al., 2015). Furthermore, the parents do not feel that such other interventions as pain medications deliver significant benefits. Essentially, the beliefs that parents hold influence the interventions that practitioners adopt.

PICO 

P (Population)	Children (0-8 years)
I (Intervention/Indicator)	Antibiotics
C (Comparison)	No antibiotics, Other interventions such as watchful waiting
O (Outcome)	Reduction in infections/ Quick recovery

PICO Question: The PICO question is important as it investigates the impact that the selected intervention has on the target population and how it compares with other measures as evaluated using the outcome. The following is the PICO question that the inquiry seeks to answer: “Compared to such other interventions as watchful waiting, how effective and safe is the administration of antibiotics in reducing AOM infections among children aged 0-8 years?

Search Strategy 

As part of this research project, an extensive and thorough search for literature was performed. The following section contains a description of the steps that were followed in conducting the search and a discussion of some of the articles that were selected.

Keywords 

Keywords play a critical role in the search for literature. Using keywords, one is able to narrow down their search and find literature that is both current and relevant. The keywords need to reflect the information that one hopes to find. The following are the keywords that were used: acute otitis media, antibiotics, pediatric, children, antibiotic resistance, treatment, risk factors and diagnosis. Thanks to these keywords, journal articles that explore different aspects of AOM were identified.

Number and Types of Articles 

As a result of the search for literature, various articles were found. A total of five research articles and three non-research articles were selected. Essentially, the research articles detailed findings of studies that researchers conducted. On the other hand, the non-research articles contained opinions, commentary and policy guidelines. Among the research articles is the one by Sakulchit and Goldman (2017). In this article, these authors compare the effectiveness and safety of antibiotics and watchful waiting as interventions for AOM. They begin with a look at studies which have found that antibiotics are effective for children who are at least two years old. While these researchers do not establish if it is better than the administration of antibiotics, they note that watchful waiting can be an appropriate intervention as it does not present the adverse impacts associated with antibiotics. Hansen et al. (2015) are another group of scholars who authored a research article. The focus of the article is the impact that the beliefs that parents hold have on the treatment of AOM. After interviewing 15 parents, they found that most of these parents have confidence in physicians and are convinced that antibiotics are the best approach for treating AOM. They also observed that many parents do not have a full understanding of AOM and fail to recognize the important function that pain medication can play in the management of this condition.

In addition to the research articles, non-research articles also formed part of the literature that was reviewed. The article by Young (2016) is among these. In the article, Young addresses such issues as the causes of AOM and the diagnostic criteria. He also sheds light on how antibiotics have been used to treat this condition for years. Young cautions that as practitioners continue to prescribe AOM, this condition will increasingly become resistant to the antibiotics. Recommendations that parents should adopt as they seek to prevent AOM are another issue that Young addresses in the article. The article penned by Harmes (2013) and his colleagues is yet another that was obtained through the literature search. Such issues as the etiology, risk factors, and diagnosis of AOM are the key focus of the article. Furthermore, the article explores the role that antibiotics therapy continues to play in the treatment of AOM. As is the case with Young, Harmes and her team also warn that AOM is becoming resistant due to the excessive and unnecessary prescription of antibiotics.

Evidence Matrix 

Authors	Journal Name/ WGU Library	Year of Publication	Research Design	Sample Size	Outcome Variables Measured	Level (I–III)	Quality (A, B, C)	Results/Author’s Suggested Conclusions
Hansen, P., Howlett, J., Mar, C. D., & Hoffmann, T. C.	BMC Family Practice	2015	Prospective cohort study	15	Reasons for seeking services of physician, beliefs regarding treatment of AOM, and causes of AOM.	II	B	Most parents trust practitioners and believe that antibiotics work. Authors advise that parents should be provided with more information regarding alternative treatment approaches.
Abbott, P., Gunasekera, H., & Leach, A. J. et al.	Biomed Central	2016	Randomized controlled trial	Not stated	Participants with signs of AOM, resolution of symptoms, new antibiotic prescriptions	I	B	Watchful waiting is a cost-effective alternative to antibiotics therapy
Sakulchit, T., & Goldman, R. D.	Canadian Family Physician	2017	Systematic review	Not stated	Effectiveness of antibiotics, effectiveness of watchful waiting	I	A	Watchful waiting is effective and should be adopted as an alternative
Boatright, C., Holcomb, L., & Replogle, W.	Pediatric Nursing	2015	Retrospective descriptive study	100	AOM diagnosis, prescribed treatment	III	B	Patients who do not meet all the diagnostic criteria for AOM are given antibiotics. Authors propose that practitioners should follow established guidelines when diagnosing and treating AOM.
Waldron, C., Thomas-Jones, E., Cannings-John, R. et al.	Biomed Central	2016	Randomized controlled trial	380	AOM symptoms, cost effectiveness of treatment, adverse effects of treatment, audiometry, tympanometry	I	B	There is need for development of more cost-effective and safe approaches to treating AOM.

Practice Change Proposal 

All the articles summarized in the table above indicate that AOM is a serious condition that demands the continued dedication and effort of medical practitioners. However, what is clearer from the articles is that there is a problem with the interventions that practitioners are using. Many of the practitioners use antibiotics as the first line intervention. For instance, as Hansen and his team observed that many parents place faith in physicians who prescribe antibiotics for their children who have developed AOM. While it is true that the antibiotics present some benefit, it has been associated with adverse effects. In addition to causing complications in children, the continued and unnecessary use of antibiotics adds to the resistance problem. It is evident that a change in how AOM is treated is needed. A recommendation is hereby issued that practitioners should abandon AOM and offer children with AOM other alternatives. For example, Abbott et al. and Sakulchit and Goldman confirm that watchful waiting is an effective strategy that is devoid of the numerous drawbacks that limit the effectiveness and the safety of antibiotics. If they are truly dedicated to tackling AOM and the antibiotics resistance problem, physicians should be more reluctant to prescribe antibiotics and instead implement other interventions that are safer and equally effective.

Implementation Process 

Key Stakeholders 

The implementation of the proposal presented above will require the involvement of various stakeholders. Parents and practitioners are the main stakeholders whose participation in the implementation process is essential for success. Hansen and his colleagues noted that most parents do not understand how AOM develops. Moreover, the parents fail to recognize that there are interventions beyond antibiotics which deliver immense benefits. In essence, Hansen and his team learnt that the beliefs that parents hold determine how AOM is treated. For antibiotics to be abandoned as the preferred treatment approach, parents must be persuaded to accept that such other interventions as watchful waiting work. Practitioner involvement is also needed. All the different articles lamented that practitioners continue to prescribe antibiotics despite the fact that AOM is becoming increasingly resistant. Through an education and awareness campaign, it is possible to challenge the practitioners to invest in alternative treatments. Legislators are another group of stakeholders whose efforts will determine if the proposed change is implemented smoothly. The practitioners are over-prescribing antibiotics because there lack laws that forbid this practice. When the legislators enact laws and guidelines governing the prescription of antibiotics, it can be expected that the US will be successful in its quest to eradicate AOM and tackle antibiotics resistance.

Barriers 

As is the case with other changes, the implementation of the proposed reform will be met with challenges. If not addressed properly, the challenges will undoubtedly derail progress. One of the barriers that could hamper implementation is lack of support from the stakeholders identified above. As noted earlier, many parents are convinced that antibiotics work. It will be difficult to persuade these parents to consider other approaches. Physicians could be another source of hindrance. For years, they have prescribed antibiotics for children with AOM. It will require immense effort for these practitioners to embrace new interventions whose effectiveness has not been conclusively established. Another barrier that threatens to hinder implementation is replacing antibiotics with other interventions. For example, watchful waiting has been identified as a promising alternative. However, such scholars as Hansen do not recommend it with confidence. They adopt a cautious tone that indicates that this intervention is not fully developed and may not be ready for wide-scale adoption.

Strategies for Barriers 

The barriers discussed above must be addressed if the successful implementation of the proposed change is to be secured. Education holds the key to addressing the problem of gaining support from stakeholders. For example, through education, it is possible to lead practitioners and parents to recognize that alternative treatments actually work. The education needs to focus on the adverse effects that antibiotics have been shown to present and the tremendous benefit that alternative approaches hold. To make the education effective, a demonstration of the effectiveness of the alternatives should be offered. The demonstration will clear any doubt about whether the alternatives actually work.

Indicator to Measure Outcome 

After a change has been implemented, it is vital to measure outcomes. The measurement allows for a determination to be made regarding the success of the implementation process. If the outcomes have been achieved, it can be concluded that the change has been implemented without hitches. A reduction in the incidence of AOM among children with fewer reports of complications is the main outcome that will be used to assess the effectiveness of the implementation process. The purpose of the proposed change is to challenge practitioners, parents and other stakeholders to embrace alternative treatments for AOM. To determine if this purpose has been fulfilled, focus will be given to the experiences of the children who have been provided with alternative treatment. If they report improvement without the adverse effects associated with antibiotics, this will be taken as evidence that the change process occurred successfully.

In conclusion, AOM remains one of the most prevalent conditions among children. As part of efforts to tackle this condition, various interventions have been developed. The administration of antibiotics is among these interventions. While generally effective, the antibiotics have been blamed for various adverse effects. Furthermore, as practitioners continue to prescribe antibiotics, they compound the resistance problem. There are such alternatives as watchful waiting that are promising. Further investment in these alternatives is needed so as to persuade parents and physicians to embrace them in favor of antibiotics. In addition to curbing AOM, the alternatives will also fuel progress in the battle against antibiotic resistance.

References

Abbott, P., Gunasekera, H., Leach, A. J. et al. (2016). A multi-centre open-label randomised noninferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial. DOI 10.1186/s13063-016-1247-y

Boatright, C., Holcomb, L., & Replogle, W. (2015). Treatment patterns for pediatric acute otitis media: a gap in evidence-based theory and clinical practice. Pediatric Nursing, 41 (6), 271-6.

Centers for Disease Control and Prevention (CDC). (2015). Health People 2020: oral health objectives. Retrieved October 19, 2018 from https://www.cdc.gov/oralhealth/healthy_people/index.htm

Hansen, M. P., Howlett, J., Mar, C. D., & Hoffmann, T. C. (2015). Parents’ beliefs and knowledge about the management of acute otitis media: a qualitative study. BMC Family Practice. DOI: 10.1186/s12875-015-0297-7

Harmes, K. M., Blackwood, A., Burrows, H. L., Cooke, J. M., Harrison, V., & Passamani, P. P. (2013). Otitis media: diagnosis and treatment. American Family Physician, 88 (7), 435-40.

Pichichero, M. E. (2000). Acute otitis media: part II: treatment in an era of increasing antibiotic resistance. American Family Physician, 61 (8), 2410-15.

Sakulchit, T., & Goldman, R. D. (2017). Antibiotic therapy for children with acute otitis media. Canadian Family Physician, 63, 685-90.

Waldron, C., Thomas-Jones, E., Cannings-Jon, R. et al. (2016). Oral steroids for the resolution of otitis media with effusion (OME) in children (OSTRICH): study protocol for a randomized controlled trial. Biomed Central. DOI: 10.1186/s13063-016-1236-1

Young, K. (2016). Pediatric otitis media: to treat or not to treat with antibiotics. Continuing Education, 11 (12).