The Determinants to Effective Diagnosis and Management of Otitis Media in Aboriginal Children in Primary Care From the Perspective of Health Care Practitioners

OBJECTIVE: To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of Health Care Providers (HCPs). SETTING: A large regional town in the Kimberley region of Western Australia. PARTICIPANTS: Thirty HCPs to Aboriginal children. DESIGN: A qualitative, aboriginal co-designed, participatory action research study with semi-structured interviews and focus groups. RESULTS: Barriers were identified throughout the child's presentation and management and included challenges with paediatric ear examinations, earwax obstructing the view of the tympanic membrane, unfamiliarity with diagnostic tools, multiple guidelines with varying recommendations, and confusion with accessing ENT specialists. Multiple facilitators were identified and included training HCPs in paediatric examination techniques and wax removal, a single best practice guideline, and system changes to facilitate access to ENT specialist support if required. Importantly, an expanded clinical role of Aboriginal Health Practitioners (AHPs) was identified to augment efficient and effective clinical OM assessment and management in children presenting to clinic. CONCLUSIONS: All barriers could potentially be overcome through a programme that enhances theoretical knowledge and practical skills in paediatric ear examination, otoscopy, and safe, timely removal of earwax, improved communication with ENT specialists, and an expanded clinical role for AHPs. Our findings carry important implications for managing OM in primary care services across Australia.