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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.
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