Barriers and Facilitators to Implementing Watchful Waiting for Pediatric Acute Otitis Media.

Abstract

To assess facilitators and barriers to watchful waiting for nonsevere acute otitis media (AOM), as recommended by the American Academy of Pediatrics, rather than immediate antibiotic initiation. In a qualitative study, purposeful sampling was used in to recruit clinicians and clinician administrators from three health care systems for semistructured interviews and convenience sampling was used to recruit parents of children aged 6 months or older with a recent diagnosis of AOM for focus groups. The Practical Robust Implementation and Sustainability Model guided the study. Interviews were analyzed using the Rapid Assessment Process. Forty-four participants (23 clinicians/administrators and 21 parents) engaged in interviews and focus groups. Barriers to watchful waiting included lack of standard workflows and systems to support the process, time constraints, bidirectional trust, unclear instructions and processes for parents, fear of complications, parental misconceptions about antibiotics, and parental concerns about pain management. Patient-level obstacles included social factors, such as access to transportation, communication limitations, and finances. Facilitators included a strong stewardship culture, family/clinician rapport, and parent desire to participate in decision-making. Our findings suggest clinicians, administrators, and parents are receptive to watchful waiting for management of AOM in children. Several modifiable factors were identified that could support the utilization of watchful waiting and reduce unneeded antibiotic use among children. NCT06034080.