Paredes P, de la Peña M, Flores-Guerra E, Diaz J, Trostle J
Instituto de Investigacion Nutricional, Lima, Peru.
Soc Sci Med. 1996 Apr;42(8):1141-53. doi: 10.1016/0277-9536(95)00387-8.
Proper diarrhoea treatment has received greater attention during the last 10 years. However, the unjustified use of medicines to treat simple episodes of acute diarrhoea continues to divert attention and available resources away from appropriate treatment. A study to identify the factors determining prescribing practices for diarrhoea treatment was carried out in a peri-urban part of Lima, Peru in 1991. Physicians were interviewed, and then their practice was assessed by visits of confederates with healthy children described as ill, by interviews with mothers of sick children leaving the clinic, or by both of these methods. Physicians' reported practices in treating diarrhoea cases were compared to their actual practices. Although physicians' knowledge of drug management seemed to influence the low frequency of prescription of antidiarrhoeal drugs, it did not have the same influence on prescription of antimicrobials. Our results suggest that the diagnostic process and consequently the treatment decision do not follow a scientific rationale for this illness. The physicians' prescribing practices seemed to be more related to agreement with social expectations and the caretakers' perception of the physicians' role than they were to the standard biomedical rules of diarrhoea management.
在过去十年中，适当的腹泻治疗受到了更多关注。然而，不合理地使用药物治疗单纯性急性腹泻发作，继续使人们的注意力和可用资源从适当的治疗上转移。1991年在秘鲁利马的一个城郊地区开展了一项研究，以确定决定腹泻治疗处方行为的因素。对医生进行了访谈，然后通过安排健康儿童假扮生病的同盟者进行探访、与离开诊所的患病儿童的母亲进行访谈或采用这两种方法来评估他们的处方行为。将医生报告的腹泻病例治疗行为与其实际行为进行了比较。虽然医生对药物管理的了解似乎影响了止泻药的低处方率，但对抗菌药物的处方没有同样的影响。我们的结果表明，诊断过程以及因此的治疗决策并未遵循针对这种疾病的科学原理。医生的处方行为似乎更多地与符合社会期望以及看护者对医生角色的认知有关，而不是与腹泻管理的标准生物医学规则有关。
