Wezorek C M, Dean B S, Krenzelok E P
Pittsburgh Poison Center, Children's Hospital of Pittsburgh, PA.
Vet Hum Toxicol. 1992 Apr;34(2):151-3.
Non-compliance with prescribed therapies has long been recognized by medical practitioners in all fields as an important factor influencing the probability of a favorable outcome. Few references in the literature address this factor with regard to poisoning. Principles of assessing and improving compliance may also be applied to the advice given by poison information providers. Cases involving lay callers, who failed to comply with poison center recommendations, were studied. The type of advice, reason given for failing to comply, and outcome were assessed. 205 poisoning cases from the 12-mo period were analyzed involving 129 children and 76 adults. In 34 pediatric exposures of children where syrup of ipecac was recommended but not given, 29.4% of parents cited the influence of a family member in deciding not to comply; 47% indicated the potential risk of the exposure was not perceived accurately. In 90 cases of non-compliant referrals of children to emergency departments, 60% of parents minimized the threat of a serious outcome despite explanation of the expected risk. In 76 adult cases, 70 patients refused referral to an emergency department; 26% admitted to sociopsycological reasons, including public status, undisclosed drug abuse, or fear of reprisal. Sequelae developed in 31% of the children and 46% of the adults which may not have occurred if poison center recommendations had been followed. Willingness to comply with a recommended behavior is influenced by factors such as motivation, concern, perceived threat posed by the exposure, and perceived barriers. A compliance model relative to poisoning is needed to reduce risk and promote a favorable outcome.
长期以来，所有医学领域的从业者都认识到不遵守规定治疗方法是影响良好治疗结果概率的一个重要因素。文献中很少有关于中毒方面涉及这一因素的参考资料。评估和提高依从性的原则也可应用于中毒信息提供者给出的建议。对涉及未遵守中毒控制中心建议的非专业来电者的案例进行了研究。评估了建议的类型、不遵守的原因以及结果。分析了12个月期间的205例中毒病例，其中包括129名儿童和76名成人。在34例推荐使用吐根糖浆但未给儿童使用的儿科暴露病例中，29.4%的家长表示是受家庭成员影响而决定不遵守；47%表示未准确认识到暴露的潜在风险。在90例未遵守将儿童转诊至急诊科建议的病例中，尽管已解释预期风险，但60%的家长仍淡化了严重后果的威胁。在76例成人病例中，70名患者拒绝转诊至急诊科；26%承认是出于社会心理原因，包括公众形象、未公开的药物滥用或害怕报复。如果遵循中毒控制中心的建议，31%的儿童和46%的成人可能不会出现后遗症。遵守推荐行为的意愿受动机、关注程度、暴露所带来的感知威胁以及感知障碍等因素影响。需要一个与中毒相关的依从性模型来降低风险并促进良好结果。
