PEDIATRICS Vol. 104 No. 3 September 1999, p. e29

ELECTRONIC ARTICLE:
Oral Rehydration Solution for Acute Diarrhea Prevents Subsequent Unscheduled Follow-up Visits

Received Aug 28, 1998; accepted Apr 6, 1999.

Christopher Duggan^*, Jack Lasche, Martha McCarty, Kathleen Mitchell, Robert Dershewitz, Stephen J. Lerman, Margaret Higham, Annette Radzevich, and Ronald E. Kleinman^*

From the ^* Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital and Massachusetts General Hospital, Harvard Medical School; and  Harvard Vanguard Medical Associates, Harvard Pilgrim Health Care, Boston, Massachusetts.

Background.  Oral rehydration solutions (ORS) for the treatment of acute diarrhea remain an underutilized therapy in the United States, despite multiple clinical trials confirming their efficacy and safety. Economic barriers to their use have been identified.

Objective.  To determine whether providing ORS to patients at the time of their office visit for acute diarrhea can increase ORS utilization and reduce unscheduled follow-up visits.

Design.  Randomized, controlled clinical trial.

Setting.  Seven health centers of a large health maintenance organization.

Participants.  Children (N = 479) 0 to 60 months of age with acute diarrhea (at least three watery or loose stools in the previous 24 hours for 7 days).

Intervention.  Prescription for 2 quarts of ORS filled for free at on-site pharmacy plus written instructions versus written instructions alone.

Primary Outcome Measures.  Self-reported use of ORS; unscheduled follow-up visits in office, urgent care, and/or emergency department setting.

Results.  Subjects in the intervention group were significantly more likely to use ORS after the initial office visit (85% vs 71%; RR: 1.19; 95% CI: 1.08-1.32). Of the standard treatment group subjects, 40 (17.3%) sought unscheduled follow-up care for diarrhea versus 27 (10.9%) of the intervention group subjects (RR: 0.63; 95% CI: 0.40-0.99). Subjects seeking unscheduled follow-up care tended to younger (15.7 vs 19.4 months old), have more stools (7.1 vs 6.2 stools), and more vomiting episodes (4.1 vs 3.0) in the 24 hours before initial evaluation than those not seeking unscheduled follow-up care. Multivariate analysis showed that randomization to the intervention group was associated with a 25% reduction in unscheduled follow-up visits for acute diarrhea.

Conclusions.  Providing ORS to families at the time of their office visit for acute diarrhea is associated with a significant increase in ORS use and substantially reduces the need for unscheduled follow-up visits. Health maintenance organizations should consider routine provision of ORS to children presenting with acute diarrhea.  Key words:  diarrhea, oral rehydration solutions, practice-based research, dehydration, vomiting.

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