Balbus John M, Harvey Chinonye E, McCurdy Leyla Erk
Environmental Defense, Washington, DC 20009, USA.
J Agromedicine. 2006;11(1):27-38. doi: 10.1300/J096v11n01_04.
This pilot project, carried out under the National Strategies for Health Care Providers: Pesticides Initiative, assessed the attitudes, beliefs and practices of pediatricians, nurse practitioners, physicians assistants, and nurses in the metropolitan Washington, D.C., area and the surrounding rural counties regarding health effects of pesticide toxicity and continuing education on pesticide toxicity in the years 2001-2002.
Data were collected from practitioners (physicians, physician assistants, and nurse practitioners) and nurses using questionnaires as well as from practitioners using focus groups. Sites for questionnaire distribution and focus groups were selected to represent a variety of practice types and geographic settings. One-hundred-sixty questionnaires from practitioners and 43 from nurses were analyzed. These issues were probed further in six focus groups with 29 participants.
Most respondents in both groups did not frequently diagnose or ask questions about pesticide toxicity on patient histories. Most focus group participants were more comfortable answering questions about acute pesticide toxicity, and many relied on poison control centers for assistance with management of acute cases. They expressed less understanding and more uncertainties about chronic toxicity. When asked questions by patients, 64% of practitioners and 69% of nurses felt poorly prepared to answer them. Forty percent of practitioners but only 26% of nurses felt it was important to obtain more information on pesticides. There were divergent preferences on ways to obtain continuing medical education (CME) in general, but a recurrent theme was the need to make CME on pesticide toxicity clinically relevant and one topic among several in a CME conference. Lectures and short courses were the most commonly preferred modes of education among both practitioners and nurses.
Educational materials to reach this population of pediatric clinicians on pesticides, as well as other environmental health topics, should make the case justifying the importance of the topics, highlight information of clinical relevance, and use a variety of media. These results should be confirmed before being generalized to a broader group of clinicians, although the consistency of findings between focus groups suggests they are robust, at least for this geographic area.
本试点项目是在《医疗保健提供者国家战略：农药倡议》下开展的，评估了2001 - 2002年期间华盛顿特区大都市地区及周边农村县的儿科医生、执业护士、医师助理和护士对农药毒性健康影响的态度、信念和做法，以及关于农药毒性的继续教育情况。
通过问卷调查从从业者（医生、医师助理和执业护士）和护士中收集数据，并通过焦点小组从从业者中收集数据。问卷分发和焦点小组的地点选择旨在代表各种执业类型和地理环境。分析了来自从业者的160份问卷和来自护士的43份问卷。在有29名参与者的6个焦点小组中进一步探讨了这些问题。
两组中的大多数受访者在患者病史中不经常诊断或询问农药毒性问题。大多数焦点小组参与者对回答有关急性农药毒性的问题更得心应手，许多人在急性病例管理方面依赖中毒控制中心提供帮助。他们对慢性毒性的理解较少且不确定性更多。当被患者问到问题时，64%的从业者和69%的护士觉得自己准备不足无法回答。40%的从业者但只有26%的护士认为获取更多农药信息很重要。总体而言，在获取继续医学教育（CME）的方式上存在不同偏好，但一个反复出现的主题是需要使关于农药毒性的CME具有临床相关性，并且是CME会议中多个主题之一。讲座和短期课程是从业者和护士中最常偏好的教育方式。
针对这群儿科临床医生的农药以及其他环境卫生主题的教育材料，应该说明这些主题的重要性，突出临床相关信息，并使用多种媒体。在推广到更广泛的临床医生群体之前，这些结果应得到证实，尽管焦点小组之间结果的一致性表明它们至少在这个地理区域是可靠的。
