South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka ; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
PLoS One. 2013 Aug 19;8(8):e71787. doi: 10.1371/journal.pone.0071787. eCollection 2013.
In developing countries, including Sri Lanka, a high proportion of acute poisoning and other medical emergencies are initially treated in rural peripheral hospitals. Patients are then usually transferred to referral hospitals for further treatment. Guidelines are often used to promote better patient care in these emergencies. We conducted a cluster randomized controlled trial (ISRCTN73983810) which aimed to assess the effect of a brief educational outreach ('academic detailing') intervention to promote the utilization of treatment guidelines for acute poisoning.
This cluster RCT was conducted in the North Central Province of Sri Lanka. All peripheral hospitals in the province were randomized to either intervention or control. All hospitals received a copy of the guidelines. The intervention hospitals received a brief out-reach academic detailing workshop which explained poisoning treatment guidelines and guideline promotional items designed to be used in daily care. Data were collected on all patients admitted due to poisoning for 12 months post-intervention in all study hospitals. Information collected included type of poison exposure, initial investigations, treatments and hospital outcome. Patients transferred from peripheral hospitals to referral hospitals had their clinical outcomes recorded. There were 23 intervention and 23 control hospitals. There were no significant differences in the patient characteristics, such as age, gender and the poisons ingested. The intervention hospitals showed a significant improvement in administration of activated charcoal [OR 2.95 (95% CI 1.28-6.80)]. There was no difference between hospitals in use of other decontamination methods.
This study shows that an educational intervention consisting of brief out-reach academic detailing was effective in changing treatment behavior in rural Sri Lankan hospitals. The intervention was only effective for treatments with direct clinician involvement, such as administering activated charcoal. It was not successful for treatments usually administered by non-professional staff such as forced emesis for poisoning.
Controlled-Trials.com ISRCTN73983810 ISRCTN73983810.
在包括斯里兰卡在内的发展中国家，很大一部分急性中毒和其他医疗急症最初是在农村周边医院治疗的。然后，这些患者通常会被转移到转诊医院进行进一步治疗。指南通常被用来促进这些紧急情况下更好的患者护理。我们进行了一项集群随机对照试验（ISRCTN73983810），旨在评估一项简短的教育外展（学术详述）干预措施，以促进急性中毒治疗指南的使用，从而改善患者的治疗效果。
这项集群 RCT 在斯里兰卡的中北部省进行。该省的所有周边医院都被随机分配到干预组或对照组。所有医院都收到了指南的副本。干预医院接受了一个简短的外展学术详述研讨会，该研讨会解释了中毒治疗指南以及旨在在日常护理中使用的指南推广项目。在干预后的 12 个月内，所有研究医院都对所有因中毒而入院的患者进行了数据收集。收集的信息包括中毒暴露类型、初步检查、治疗和医院结局。从周边医院转院到转诊医院的患者记录了他们的临床结局。共有 23 家干预医院和 23 家对照医院。患者的特征，如年龄、性别和摄入的毒物，没有显著差异。干预医院在使用活性炭方面有显著改善[比值比 2.95（95%置信区间 1.28-6.80）]。医院之间在使用其他去污方法方面没有差异。
这项研究表明，由简短的外展学术详述组成的教育干预措施在改变斯里兰卡农村医院的治疗行为方面是有效的。这种干预措施仅对直接涉及临床医生的治疗方法有效，例如使用活性炭。对于通常由非专业人员（如催吐）实施的治疗方法无效，如催吐治疗中毒。
受控试验。com ISRCTN73983810 ISRCTN73983810。
