The Effectiveness of Different Interventions to Promote Poison Prevention Behaviours in Households with Children: A Network Meta-Analysis

Abstract

BackgroundThere is evidence from 2 previous meta-analyses that interventions to promote poison prevention behaviours are effective in increasing a range of poison prevention practices in households with children. The published meta-analyses compared any intervention against a “usual care or no intervention” which potentially limits the usefulness of the analysis to decision makers. We aim to use network meta-analysis to simultaneously evaluate the effectiveness of different interventions to increase prevalence of safe storage of i) Medicines only, ii) Other household products only, iii) Poisons (both medicines and non-medicines), iv) Poisonous plants; and v) Possession of poison control centre (PCC) telephone number in households with children.MethodsData on the effectiveness of poison prevention interventions was extracted from primary studies identified in 2 newly-undertaken systematic reviews. Effect estimates were pooled across studies using a random effects network meta-analysis model.Results28 of the 47 primary studies identified were included in the analysis. Compared to usual care intervention, the intervention with education and low cost/free equipment elements was most effective in promoting safe storage of medicines (odds ratio 2.51, 95% credible interval 1.01 to 6.00) while interventions with education, low cost/free equipment, home safety inspection and fitting components were most effective in promoting safe storage of other household products (2.52, 1.12 to 7.13), safe storage of poisons (11.10, 1.60 to 141.50) and possession of PCC number (38.82, 2.19 to 687.10). No one intervention package was more effective than the others in promoting safe storage of poisonous plants.ConclusionThe most effective interventions varied by poison prevention practice, but education alone was not the most effective intervention for any poison prevention practice. Commissioners and providers of poison prevention interventions should tailor the interventions they commission or provide to the poison prevention practices they wish to promote.HighlightsNetwork meta-analysis is useful for comparing multiple injury-prevention interventions.More intensive poison prevention interventions were more effective than education alone. Education and low cost/free equipment was most effective in promoting safe storage of medicines. Education, low cost/free equipment, home safety inspection and fitting was most effective in promoting safe storage of household products and poisons. Education, low cost/free equipment and home inspection were most effective in promoting possession of a poison control centre number.None of the intervention packages was more effective than the others in promoting safe storage of poisonous plants.

Safe Storage of Opioid Pain Relievers Among Adults Living in Households With Children

“…10 This combined approach was recently shown, in a network meta-analysis, to increase poison prevention practices in households with children. 13 Limited national data exist to assess awareness of OPR dangers among adults with children living in the home or to examine storage beliefs and practices among this group. 14 Our larger study 15 addressed this gap with data from a nationally representative sample of US adults who reported OPR use in the past 12 months, regardless of the presence of children in the home; this study focuses exclusively on respondents with children in the home.…”

A decision analytic model to investigate the cost-effectiveness of poisoning prevention practices in households with young children

“…We developed a probabilistic decision model to compare the cost-effectiveness of seven home safety interventions to increase uptake of poison prevention behaviours in households with children aged 0–4 years. The intervention strategies evaluated in the model were identified from a recently published systematic review and network meta-analysis [ 9 ] and include: Usual care Education (more than usual safety education) Provision of low cost/free equipment Education + provision of low cost/free equipment Education + provision of low cost/free equipment + home safety inspection Education + provision of low cost/free equipment + fitting (i.e. free installation of equipment) Education + provision of low cost/free equipment + home safety inspection + fitting …”

“…Assumed the same for all interventions. 0.90 Fixed pEff Probability of safe storage of medicines given the intervention Achana et al, 2015 [ 9 ] (1) Usual care (2) Education (3) Provision of low cost/free low cost/free equipment (4) Education + provision of low cost/free equipment (5) Education + equipment + home safety inspection (6) Education + equipment + fitting (7) Education + equipment + home safety inspection + fitting 0.87 (95%CrI 0.56, 0.98) 0.90 (95%CrI 0.61, 0.98) 0.93 (95%CrI 0.65, 0.99) 0.94 (95%CrI 0.74, 0.99) 0.90 (95%CrI 0.56, 0.99) 0.90 (95%CrI 0.59, 0.98) 0.93 (95%CrI 0.66, 0.99) Posterior distribution of absolute intervention effects from network meta-analysis. pIngest Probability of unintentional exposure/ingestion Orton et al, 2014 [ 10 ] Tyrrell et al, 2012 [ 33 ] Office for National Statistics, 2013 [ 34 ] Orton et al [ 10 ] – incidence of poisonings in the UK for period 2005–2009 is 30.1 (95 % CI 29.1–31.2).…”

“…Systematic reviews [ 6 – 8 ] and a recent network meta-analysis [ 9 ] show home safety interventions including education, home safety inspections, provision of free or low cost safety equipment and fitting of equipment are effective in promoting some poison prevention practices in families with children. However there is little published evidence on the cost-effectiveness of these interventions.…”

Does improving poison prevention practices reduce childhood poisoning rates

“…For most policy-makers, changes in behaviours or practices may be less persuasive than changes in actual rates in morbidity or mortality, albeit altering behaviours of outcomes with many risks is often associated with eventual reduction in the outcomes. A recent meta-analysis (Achana et al, 2015) also shied away from the important question as to whether improving poison prevention practices from interventions translated into actual decline in childhood poisoning rates as have many prior studies (Kendrick et al, 2008). This should indeed be the subject of future inquiry into research on childhood poisoning.…”