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Antihistamine Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement.
Otolaryngol Head Neck Surg. 2015 Dec; 153(6):935-42.OH

Abstract

OBJECTIVES

The otitis media with effusion (OME) clinical practice guideline endorsed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians recommends against using antihistamines. Avoiding antihistamines was previously endorsed as a performance measure by the National Quality Foundation, but data regarding current practice patterns are lacking. Thus, our objectives were to evaluate (1) antihistamine usage in association with OME, (2) whether practice varies according to visit setting, and (3) if usage patterns are such that a future change would be measurable.

STUDY DESIGN

Cross-sectional analysis.

SETTING

Ambulatory visits in the United States.

SUBJECTS AND METHODS

National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys, 2005-2010; univariate, multivariate, and stratified analyses of antihistamine usage were performed.

RESULTS

A total of 133,968 observations representing 1.49 × 10(9) pediatric visits met inclusion criteria. Antihistamines were used in 9.5% of OME visits, as opposed to 5.5% of visits without OME (univariate odds ratio, 1.83; 95% confidence interval, 1.02-3.29; P = .042). Multivariate analysis confirmed that OME was associated with a significant increase in nonsedating antihistamine usage (odds ratio, 3.53; 95% confidence interval, 1.62-7.71; P = .002), when adjusted for age, sex, race/ethnicity, allergic conditions and nasal inflammatory diagnoses.

CONCLUSIONS

Oral antihistamines are significantly more likely to be administered when OME is diagnosed. Although antihistamine use for OME is proportionally low, the high prevalence of OME creates an opportunity for quality improvement. Future changes in clinician behavior in response to an updated guideline or related performance metric could be monitored.

Authors+Show Affiliations

Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA.Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA jennifer_shin@meei.harvard.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26408558

Citation

Prince, Anthony A., et al. "Antihistamine Use for Otitis Media With Effusion: Ongoing Opportunities for Quality Improvement." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 153, no. 6, 2015, pp. 935-42.
Prince AA, Rosenfeld RM, Shin JJ. Antihistamine Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngol Head Neck Surg. 2015;153(6):935-42.
Prince, A. A., Rosenfeld, R. M., & Shin, J. J. (2015). Antihistamine Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 153(6), 935-42. https://doi.org/10.1177/0194599815606709
Prince AA, Rosenfeld RM, Shin JJ. Antihistamine Use for Otitis Media With Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngol Head Neck Surg. 2015;153(6):935-42. PubMed PMID: 26408558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antihistamine Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. AU - Prince,Anthony A, AU - Rosenfeld,Richard M, AU - Shin,Jennifer J, Y1 - 2015/09/25/ PY - 2015/07/07/received PY - 2015/08/27/accepted PY - 2015/9/27/entrez PY - 2015/9/27/pubmed PY - 2016/4/5/medline KW - antihistamines KW - otitis media with effusion KW - performance metric KW - practice patterns KW - quality improvement SP - 935 EP - 42 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 153 IS - 6 N2 - OBJECTIVES: The otitis media with effusion (OME) clinical practice guideline endorsed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians recommends against using antihistamines. Avoiding antihistamines was previously endorsed as a performance measure by the National Quality Foundation, but data regarding current practice patterns are lacking. Thus, our objectives were to evaluate (1) antihistamine usage in association with OME, (2) whether practice varies according to visit setting, and (3) if usage patterns are such that a future change would be measurable. STUDY DESIGN: Cross-sectional analysis. SETTING: Ambulatory visits in the United States. SUBJECTS AND METHODS: National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys, 2005-2010; univariate, multivariate, and stratified analyses of antihistamine usage were performed. RESULTS: A total of 133,968 observations representing 1.49 × 10(9) pediatric visits met inclusion criteria. Antihistamines were used in 9.5% of OME visits, as opposed to 5.5% of visits without OME (univariate odds ratio, 1.83; 95% confidence interval, 1.02-3.29; P = .042). Multivariate analysis confirmed that OME was associated with a significant increase in nonsedating antihistamine usage (odds ratio, 3.53; 95% confidence interval, 1.62-7.71; P = .002), when adjusted for age, sex, race/ethnicity, allergic conditions and nasal inflammatory diagnoses. CONCLUSIONS: Oral antihistamines are significantly more likely to be administered when OME is diagnosed. Although antihistamine use for OME is proportionally low, the high prevalence of OME creates an opportunity for quality improvement. Future changes in clinician behavior in response to an updated guideline or related performance metric could be monitored. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/26408558/Antihistamine_Use_for_Otitis_Media_with_Effusion:_Ongoing_Opportunities_for_Quality_Improvement_ L2 - https://journals.sagepub.com/doi/10.1177/0194599815606709?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -