Poisoning Interventions

Physician-based Education Programs

Background

Physician-based educational interventions (including pharmacy-based interventions) are a means to reach not only young children but also their parents in the attempt to increase awareness about childhood poisonings, learn what preventive measures can be taken at home and work sites, and what to do in the event of an emergency.


Review of physician-based education studies:

Author

Easton-Jones, 2000

Study design and target population

Pre-test, post-test.

Community family practice center.

Intervention

Lecture to residents, distribution of free samples of Ipecac to patients.

Outcomes

Interviews of families 3 months after intervention started.

Results

109 patients/families 48% vs. 31% had Ipecac at home.

Study quality and conclusions

Very weak study design and intervention.


Author

Frankenfield et al., 1991

Study design and target population

Before and after design.

Children in kindergarten through second grade in Gallup, NM, during the third week of March, 1989. (n=700)

Intervention

Pharmacy-initiated educational intervention, including poster contest, games, and personal instruction.

Intervention took place in 8 elementary schools, including one on the Navajo reservation.

Outcomes

Exposures recorded by the New Mexico Poison Center in 1988 (before) and 1989 (after).

Results

Poison exposures dropped by 15% from 1988 (before; n=489) to 1989 (after; n=416).

Study quality and conclusions

Sparse data with only one before and one after data point.

Difficult to determine effect of intervention.

Intervention campaign was well-received by community.



Author

Dershewitz et al., 1977

and

Dershewitz, 1979

Study design and target population

Randomized controlled trial

Members of the prepaid Columbia Medical Plan (CMP) in Columbia, Maryland, with at least one child younger than 5 years, presenting for a child medical visit (n=205).

Intervention

Personalized health education program to reduce household hazards (active counseling, tailored to hazards likely for child’s age; booklet providing recommendations for eliminating hazards).

Use of 8 free outlet covers and 3 cabinet locks among all 205 families.

(Outcomes constituted child access to cleaning agents, prescription drugs, waxes and polishes, and non-prescription drugs.)

Outcomes

Unannounced home visit 4 weeks after intervention to both experimental and control groups, assessing safety hazards.

Questionnaire ascertaining mothers’ knowledge, beliefs, and behavior regarding home injury control administered concomitantly.

Compliance rate of free safety devices.

Results

No effect whatsoever of intervention on household hazard score.

Mothers in experimental group erroneously thought their homes were safer because of participation in study (based on Kappa statistic).

Experimental group had higher mean usage rate of electric outlet covers than control group (5.82 v. 4.96, p<0.05). No significant difference in usage of cabinet locks.

Study quality and conclusions

Intervention probably too broad in terms of behaviors to be affected; likely low power to see overall effect.

Actual protective effect of either outlet covers or cabinet locks not addressed.

Difficult to ascertain gereralizability of results; only 38% of population of Columbia, Maryland, were members of CMP at time of study.

Household hazards used as proxy for child injury.

Summary of physician-based education studies

The one randomized controlled trial of physician-based educational programs was most likely too broad a campaign to find a positive effect. That intervention did increase the use of outlet covers. However, the evidence to date indicates that outlet covers are probably unnecessary since the risk of injury from electrical outlets is extremely low. The other study showed some evidence that physician-based education may decrease the incidence of poisoning. Unfortunately, the results relied on data from a poison control center rather than hospital or physician records.

Recommendations on physician-based education programs

At this time, it is difficult to determine the degree of efficacy these educational interventions have and, as such, no recommendations can be made as to their implementation.

Recommendations for future research

Clearly, more research needs to be done in this area. Future studies should address specific areas of preventing poisonings. Considering the fact that children’s behavior is difficult to modify (at best) with respect to staying away from medicine, the correct intervention lies in child-resistant packaging.