Senarathna Lalith, Adams Jon, De Silva Dhammika, Buckley Nick A, Dawson Andrew H
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka.
BMC Public Health. 2008 Oct 28;8:373. doi: 10.1186/1471-2458-8-373.
Deliberate self-poisoning is a major public heath issue in developing countries. In rural Sri Lanka deliberate self-poisoning is one of the leading causes of hospital death. The majority of patients with poisoning present to rural hospitals for initial treatment that are staffed by non-specialist and often relatively junior doctors. The treatment of self-poisoning patients poses numerous clinical challenges and further difficulties are experienced if patients are uncooperative and aggressive, intoxicated with alcohol or suffering mental illness. Previous research in developed countries has examined self-poisoning patients and their treatment but little is know about self-poisoning patient care in the context of rural health provision in developing countries. This study provides the first focused exploration of the experiences and perceptions of primary care rural hospital doctors in Sri Lanka toward the treatment of self-poisoning patients.
Semi-structured in-depth interviews were conducted with fifteen doctors from rural hospitals in the North Central Province, Sri Lanka. All interviews were recorded and transcribed and subject to thematic analysis.
Participating doctors did perceive that treating self-poisoning patients in a primary care rural hospital as potentially confidence-building. However, resource issues such as the lack of medication, equipment and staffing were seen as important challenges to treating self-poisoning patients. Other challenges identified included disparity with community and other staff members regarding expectations of care, a sense of professional isolation and a lack of continuing education programs.
Addressing professional isolation through educational and trainee programs for doctors and reducing the variance in expectations between professional groups and the community has the potential to improve delivery of care for self-poisoning patients.
蓄意自我中毒是发展中国家的一个重大公共卫生问题。在斯里兰卡农村地区，蓄意自我中毒是医院死亡的主要原因之一。大多数中毒患者前往农村医院接受初始治疗，这些医院的工作人员多为非专科医生，且往往是资历相对较浅的医生。自我中毒患者的治疗带来了众多临床挑战，如果患者不合作、有攻击性、酗酒或患有精神疾病，还会面临更多困难。发达国家此前的研究调查了自我中毒患者及其治疗情况，但对于发展中国家农村卫生服务背景下的自我中毒患者护理情况知之甚少。本研究首次重点探讨了斯里兰卡农村基层医院医生对自我中毒患者治疗的经验和看法。
对斯里兰卡中北省农村医院的15名医生进行了半结构化深度访谈。所有访谈均进行了录音和转录，并进行了主题分析。
参与访谈的医生确实认为，在农村基层医院治疗自我中毒患者可能有助于增强信心。然而，药物、设备和人员配备不足等资源问题被视为治疗自我中毒患者的重要挑战。其他已识别的挑战包括在护理期望方面与社区和其他工作人员存在差异、职业孤立感以及缺乏继续教育项目。
通过为医生提供教育和培训项目来解决职业孤立问题，并减少专业群体与社区之间期望的差异，有可能改善对自我中毒患者的护理服务。
