社区药房处理疑似儿童急性中耳炎的指南一致性与抗菌药物管理：沙特阿拉伯的一项模拟患者研究

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中文摘要

引言： 急性中耳炎（AOM）是一种常见的儿科疾病，需要仔细评估以区分需要医疗转诊的儿童与适合观察等待的儿童。社区药师通常是首先被咨询的医疗专业人员；然而，关于其AOM管理质量和指南一致性的证据仍然有限。本研究评估了社区药师在不同临床严重程度情景下对儿童AOM的管理。
方法： 采用横断面模拟患者研究，使用三个标准化的儿童AOM情景：一名需要转诊的5个月大婴儿、一名适合观察等待的18个月大儿童，以及一名具有多个危险信号需要紧急转诊的5岁儿童。经过培训的模拟照护者完成了203次社区药房访视。主要结局是情景特异性的指南一致性管理。次要结局包括转诊、观察等待、抗菌药物推荐、信息收集、咨询和沟通质量。广义估计方程（GEE）逻辑回归模型考虑了模拟患者的聚类效应。
结果： 在病例1访视中，58.8%提供了指南一致性管理；病例2访视为8.8%；病例3访视为58.2%。分别有60.3%、47.1%和58.2%的访视建议转诊，而在低严重度的病例2访视中，仅13.2%建议观察等待。分别有7.4%、22.1%和22.4%的访视推荐抗菌药物，主要为局部抗生素。尽管药师通常会评估患者年龄并总体以专业方式沟通，但对症状、发热、耳漏、用药、过敏和反复感染的评估不一致。与病例2相比，病例1和病例3获得指南一致性管理的几率显著更高。
结论： 社区药师对疑似儿童AOM的管理因临床表现不同而差异很大。在观察等待、系统性临床评估和抗菌药物管理方面观察到重大差距。需要标准化分诊方案和有针对性的专业培训，以改善安全、符合指南的管理。

英文摘要

Introduction: Acute otitis media (AOM) is a common pediatric condition requiring careful assessment to distinguish children needing medical referral from those suitable for watchful waiting. Community pharmacists are often the first healthcare professionals consulted; however, evidence regarding the quality and guideline concordance of their AOM management remains limited. This study evaluated community pharmacists' management of pediatric AOM across scenarios of varying clinical severity. Methods: A cross-sectional simulated patient study was conducted using three standardized pediatric AOM scenarios: a 5-month-old infant requiring referral, an 18-month-old child suitable for watchful waiting, and a 5-year-old child with multiple red flags requiring urgent referral. Trained simulated caregivers completed 203 community pharmacy visits. The primary outcome was scenario-specific guideline-concordant management. Secondary outcomes included referral, watchful waiting, antimicrobial recommendations, information gathering, counseling, and communication quality. Generalized estimating equation (GEE) logistic regression models accounted for clustering by simulated patient. Results: Guideline-concordant management was provided in 58.8% of Case 1 visits, 8.8% of Case 2 visits, and 58.2% of Case 3 visits. Referral was recommended in 60.3%, 47.1%, and 58.2% of visits, respectively, whereas watchful waiting was recommended in only 13.2% of the low-severity Case 2 visits. Antimicrobials were recommended in 7.4%, 22.1%, and 22.4% of visits, predominantly as topical antibiotics. Although pharmacists commonly assessed patient age and generally communicated professionally, assessment of symptoms, fever, ear discharge, medication use, allergies, and recurrent infections was inconsistent. Compared with Case 2, Cases 1 and 3 had substantially greater odds of guideline-concordant management. Conclusions: Community pharmacists' management of suspected pediatric AOM varied considerably by clinical presentation. Major gaps were observed in watchful waiting, systematic clinical assessment, and antimicrobial stewardship. Standardized triage protocols and targeted professional training are needed to improve safe, guideline-concordant management.