Béria J U, Damiani M F, dos Santos I S, Lombardi C
Departamento de Medicina Social, Universidade Federal de Pelotas, RS Brazil.
Soc Sci Med. 1998 Aug;47(3):341-6. doi: 10.1016/s0277-9536(98)00078-1.
With the aim of implementing an intervention program on physician's prescribing behaviour for diarrhoea in children under five, an ethnoepidemiological study was conducted in Pelotas (Brazil), from February to April 1993. Information on prescription of drugs was obtained through record review of 381 cases of diarrhoea provided by 33 medical doctors from eight health centres. Trained field workers observed a total of 54 clinical consultations due to diarrhoea. Brief exit interviews with the mothers were performed just after the observations. Twenty-seven open-ended home interviews were made with the mothers the day after they had been observed. After all observations had been completed, open-ended interviews were conducted with 21 physicians. The results showed that there is a misunderstanding of the role of ORS in the treatment of diarrhoea: mothers want something to "cut" diarrhoea and they notice that ORS does not act in this way and doctors do not explain the action of ORS in diarrhoea management. Comparing with record reviews, during observations a child had a lower probability of receiving an antibiotic or antidiarrheal drug prescription. This finding indicates that other variables than technical skills are involved in doctor's prescribing behaviour. A lack of ability or of motivation to deal with "anxious or difficult mothers" led some doctors to enhance antibiotic or other non-recommended drugs to manage diarrhoea. Therefore, efforts to improve the quality of case management of diarrhoea, through intervention programmes in the government health sector, are needed in Pelotas.
为了实施一项针对五岁以下儿童腹泻的医生处方行为干预计划，1993年2月至4月在巴西佩洛塔斯进行了一项民族流行病学研究。通过查阅来自八个健康中心的33名医生提供的381例腹泻病例记录，获取了药物处方信息。经过培训的现场工作人员共观察了54次因腹泻进行的临床会诊。观察结束后，立即与母亲们进行了简短的离场访谈。在观察后的第二天，与母亲们进行了27次开放式家庭访谈。所有观察结束后，对21名医生进行了开放式访谈。结果表明，人们对口服补液盐（ORS）在腹泻治疗中的作用存在误解：母亲们希望有东西能“止住”腹泻，她们注意到ORS并非如此起效，而医生也没有解释ORS在腹泻管理中的作用。与记录审查相比，观察期间儿童接受抗生素或止泻药处方的可能性较低。这一发现表明，医生的处方行为涉及技术技能以外的其他变量。一些医生缺乏应对“焦虑或难缠的母亲”的能力或动力，导致他们增加抗生素或其他非推荐药物来治疗腹泻。因此，佩洛塔斯需要通过政府卫生部门的干预计划来努力提高腹泻病例管理的质量。
