Strategies for improving the therapeutic patterns used in acute diarrhea in primary medical care units. IV. Features of the treatments prescribed by the family physicians and the patients
Muñoz, O.; Guiscafré, H.; Bronfman, M.; Gutiérrez, G.
Archivos de Investigacion Medica 19(4): 371-384
1988
ISSN/ISBN: 0066-6769 PMID: 3245752 Document Number: 323399
The medical prescriptive behavior and the characteristics of the treatment prescribed by the patient himself or his relatives in acute diarrhea (AD) were analyzed with the aim of adequating the educative strategies directed both to the physician and to the population, in a group of 401 cases of AD in two units of family medicine of the Instituto Mexicano del Seguro Social. The physicians scarcely used the resource of oral hydration to prevent dehydration (33.5% in the group of less than five years of age), being more prescribed in the group of less than one year of age, where it reached a 42.2%. The medical prescription of fasting or selective suspension of foods was very elevated and varied from a 28.0 to a 49.5% with relation to different clinical characteristics. The utilization of resources of the traditional medicine varied between 10.3 to 25.0% according to different clinical characteristics, predominating the use of teas, rice water and "atoles" (drinks made from cornflour). The medical prescription of antibiotics varied between 20.3 and 40.1% of the cases and it was higher among the adults, during the first three days of the evolution of the disease, in the cases with a bigger number of stools in 24 hours and when fever and vomiting were outstanding symptoms. The presence of blood in the stools was not a criterion used by the physicians to prescribe antibiotics. This medical behavior was similar to that found in a previous study with interns and residents of family medicine in the rural area. Antiparasitics were prescribed between a 36.9 and 40.6% of the cases. The abuse in the medical prescription of antiparasitics was greater and it was associated with the patients with AD of longer evolution time and shorter number of stools in 24 hours as well as with the presence of blood in the stools; actually 90% of such prescriptions corresponded to amebicidal drugs. The overdiagnosis of intestinal amebiasis is evident since previous studies have demonstrated a frequency of intestinal amebiasis of less than 2% of the episodes of AD and from 8.5 to 19% of the cases of diarrhea with blood or dysentery. The symptomatic medical treatment was performed in a logic way but with abusement in the prescription of antidiarrheics (48.0 to 60.0% in the different age-groups). The population under study had good information on the concept of dehydration and, in a 72.8% of the children of less than five years of age, some preventive measure against dehydration had been used, although the oral hydration salts were only used in a 19.7%. The therapeutic scheme used by the family or the patient, turned out to be a complex mix of automedication with resources of the traditional medicine. Automedication was high and it reproduced the prescriptive patterns of the physicians (8.0% of antiparasitics, 15.5% of antibiotics, 28.7% of antidiarrheics and 26.2% of the medicaments used to treat fever, vomiting and abdominal colic pain). 68% of cases used resources of the traditional medicine (teas, rice water and atoles) and their utilization was higher in the families with a better socioeconomic level. The decision to use patented drugs on the part of the patient or his relatives was associated with a previous medical prescription being the key figures for such a decision the patient himself or the mother of the child. The participation of chemist was irrelevant. The family's prescription of fasting or selective suspension of foods was high, reaching a 83.2% in those with more than 15 years of age, being predominant the suspension of fats, species and condiments (spicy) among the adults while fruits and animal protein were seen in children; the mother being the important figure for this decision.