Most healthcare providers in developing countries know that Oral Rehydration Salts (ORS) are a lifesaving and inexpensive treatment for diarrhoea in children, but few prescribe it. Taking a closer look at this know-do gap, a new study has found that healthcare providers assume that patients do not want ORS, and this, in fact, played a major role in under-prescribing ORS.
Diarrhoea is a leading cause of death in children, and lives could be saved with a low-cost and widely available treatment - ORS. However, presently, nearly half of diarrhoeal cases around the world do not receive ORS, according to researchers from institutions in the U.S. and India, including the Department of Economics, Sociology and Statistics, RAND Corporation (U.S.), Sanford School of Public Policy, Duke University, Center for Public Policy, Indian Institute of Management-Bangalore, Karnataka, and Sol Price School of Public Policy, University of Southern California.
The study published in Science used a randomised controlled trial to simultaneously study the role of three leading explanations for under-prescribing of ORS - providers might think patients prefer non-ORS treatments such as antibiotics or dislike ORS because of poor taste and perceptions that ORS is not a real medicine; providers could be responding to financial incentives to sell more profitable alternatives (ORS is inexpensive and antibiotics generate nearly double the profit); and ORS stock-outs, the study authors said.
More than 2,000 providers across 253 medium-sized towns in Karnataka and Bihar participated in the study. Standardised patients (actors trained to act as patients) made unannounced visits during which they presented a case of diarrhoea for their two-year-old child. To estimate the effect of ORS stock-outs, the researchers randomly assigned all providers in half of the 253 towns to receive a six-week supply of ORS.
They found that provider misperceptions that patients do not want ORS play the biggest role in the underprescribing of ORS. They estimated that provider misperceptions explained 42% of underprescribing, whereas stock-outs and financial incentives explained only 6% and 5% respectively.
The study said 28% providers prescribed/dispensed ORS when standardised patients expressed no preference, and 55% prescribed ORS when they expressed an ORS preference. The providers thought only 18% of their patients want ORS on an average, while it was the most preferred treatment reported by patients in household surveys.
A press release from the University of Southern California, quoting the authors said, these results could be used to design interventions that encourage patients and caretakers to express preference for ORS when seeking care as well as efforts to raise awareness among providers about patients’ preferences.
