Exploration of family/whānau and general practitioner perspectives of paediatric grommet services: a mixed methods study
Michelle A. Pokorny
1 2 3 * , Elizabeth A.-L. Holt 2 3 , Hannah Fuller 2 , Peter R. Thorne 2 3
1
2
3
Abstract
Traditionally, grommet post-surgical follow-up care has been undertaken by otorhinolaryngologists (ORLs), but in a large public outpatient ORL service in Auckland, New Zealand (Counties Manukau), this responsibility has been partially devolved to general practitioners (GPs).
The purpose of this study is to explore the perspectives and experiences of families/whānau and GPs regarding grommet services for children.
A mixed methods approach was used with family/whānau comprising semi-structured interviews and a GP survey. Recruitment of families/whānau reflected the local demographic and all participants were primary carers of a child who had received grommet surgery between 2020 and 2021. All GPs were practising in clinics within the ORL service catchment area.
Twenty-eight family/whānau interviews were conducted, and 22 GPs responded to the survey. Five main themes were identified: (1) awareness of child development; (2) challenges accessing health care; (3) responses to health information; (4) importance of aftercare; and (5) preference for service provision. Most (16) GP respondents reported they should not be responsible for post-surgical follow-up after grommet insertion. Lack of capacity and funding were identified as key barriers to GP-led follow-up.
Families/whānau highly valued follow-up services and hearing evaluations after grommet insertion, and had a strong preference for clinicians with perceived expertise in ear and hearing care (ORLs and audiologists). They reported multiple barriers to receiving the desired care. Māori and Pacific families/whānau experienced additional delays for referrals into specialist services. GPs showed low support for primary care-led grommet follow-up care, with most not providing routine grommet checks after surgery.
Keywords: audiology, delivery of follow-up care, GP perceptions, grommet insertion, parent perceptions, primary health care, task-shifting.
References
1 Seo JY, Morton RP, Gerard C, et al. Persisting variance in middle ear ventilation tube insertion in Auckland children: why ethnic disparity continues. N Z Med J 2022; 135(1553): 83-90.
| Google Scholar | PubMed |
2 Schilder AG, Chonmaitree T, Cripps AW, et al. Otitis media. Nat Rev Dis Primers 2016; 2: 16063.
| Crossref | Google Scholar | PubMed |
3 Browning GG, Rovers MM, Williamson I, et al. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev [10] 2010; CD001801.
| Crossref | Google Scholar | PubMed |
4 Ungar OJ, Baris H, Oron Y, et al. Meta-analysis of time to extrusion of tympanostomy tubes by tympanic membrane quadrant. Clin Otolaryngol 2021; 46(6): 1165-1171.
| Crossref | Google Scholar | PubMed |
5 Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical practice guideline: tympanostomy tubes in children (Update). Otolaryngol Head Neck Surg 2022; 166(1_suppl): S1-S55.
| Crossref | Google Scholar | PubMed |
6 Mughal Z, Thirunavukarasu V, Darr A, et al. Follow-up care after grommet insertion in children: Review article. Int J Pediatr Otorhinolaryngol 2016; 88: 25-29.
| Crossref | Google Scholar | PubMed |
7 Austad B, Hetlevik I, Bugten V, et al. Can general practitioners do the follow-ups after surgery with ventilation tubes in the tympanic membrane? Two years audiological data. BMC Ear Nose Throat Disord 2014; 14(1): 2.
| Crossref | Google Scholar | PubMed |
8 Uppal S, Jose J, Banks P, et al. Cost-effective analysis of conventional and nurse-led clinics for common otological procedures. J Laryngol Otol 2004; 118(3): 189-192.
| Crossref | Google Scholar | PubMed |
9 Távora-Vieira D, Schrader VW, Voola M, et al. Paediatric post-grommets surgery review: audiology-led clinic. Int J Pediatr Otorhinolaryngol 2024; 183: 112035.
| Crossref | Google Scholar | PubMed |
10 Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2): 377-381.
| Crossref | Google Scholar | PubMed |
11 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
| Crossref | Google Scholar |
12 Holt EA-L, Koro L, Langridge F, et al. Worldviews of hearing health for Pacific peoples in Aotearoa New Zealand: a mixed methods study. J Prim Health Care 2024;
| Crossref | Google Scholar |
13 Milford CA, Vinayak BC. General practitioner follow-up of children undergoing grommet insertion. Can it work? Clin Otolaryngol Allied Sci 1995; 20(1): 1-2.
| Crossref | Google Scholar | PubMed |
14 Keith SAC, Ayshford CA, Verma D, et al. Modernising grommet follow up - Is it justified? Two postal surveys looking at consultant consensus and patient preference. Otorhinolaryngologist 2007; 1: 87-90.
| Google Scholar |
15 Nilsen AH, Helvik AS, Thorstensen WM, et al. ‘It is difficult for us to assess the severity!’ A qualitative analysis of parents’ expectations to postoperative care after ventilation tube surgery. Int J Pediatr Otorhinolaryngol 2024; 181: 111941.
| Crossref | Google Scholar | PubMed |
16 McCallum J, Craig L, Whittaker I, et al. Ethnic differences in acute hospitalisations for otitis media and elective hospitalisations for ventilation tubes in New Zealand children aged 0-14 years. N Z Med J 2015; 128(1416): 10-20.
| Google Scholar | PubMed |
17 Pokorny MA, Hislop RA, Holt EAL. Telephone triage does not improve attendance artes in a paediatric audiology outpatient service. N Z Med J 2022; 135(1553): 72-82.
| Google Scholar | PubMed |
18 Pokorny MA, Hislop RA, Johnston J, et al. Audiology-led model provides efficient and effective access to grommet surgery. J R Soc N Z 2024; 1-15.
| Crossref | Google Scholar |
19 Espiner E, Paine SJ, Weston M, et al. Barriers and facilitators for Māori in accessing hospital services in Aotearoa New Zealand. N Z Med J 2021; 134(1546): 47-58.
| Google Scholar | PubMed |
20 McCormack TT, Collier JA, Abel PD, et al. Attitudes to follow-up after uncomplicated surgery—hospital out-patients or general practitioner? Health Trends 1984; 16(2): 46-47.
| Google Scholar | PubMed |
21 Bailey J, Roland M, Roberts C. Is follow up by specialists routinely needed after elective surgery? A controlled trial. J Epidemiol Community Health 1999; 53(2): 118-124.
| Crossref | Google Scholar | PubMed |
22 Davies-Husband CR, Harker C, Davison T, et al. Post-surgical tympanostomy tube follow up with audiology: experience at the Freeman Hospital. J Laryngol Otol 2012; 126(2): 142-146.
| Crossref | Google Scholar | PubMed |
23 Powell J, Powell S, Lennon M, et al. Paediatric ventilation tube insertion: our experience of seventy-five children in audiology-led follow-up. Clin Otolaryngol 2015; 40(4): 385-389.
| Crossref | Google Scholar | PubMed |
