title: Barriers to use of oral rehydration therapy.
abstract: OBJECTIVE
  To identify potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners.
  
  
  METHODS
  Cross-sectional, anonymous, self-administered survey of physicians' ORT knowledge, attitudes, and practice.
  
  
  METHODS
  A national continuing medical education conference.
  
  
  METHODS
  One hundred four general pediatricians primarily in private practice (66%) who completed training after 1980 (76%).
  
  
  RESULTS
  Most respondents (83%) reported that ORT plays an important role in their management of dehydration. However, compliance with guidelines from the American Academy of Pediatrics for use of oral therapy is limited: 30% withhold ORT in children with vomiting or moderate dehydration, 50% fail to advise prompt refeeding, and only 3% advise use of a spoon or syringe. The degree of importance of ORT in physicians' practice was negatively associated with reported lack of convenience of ORT administration in the practice setting (P < .001), support staff preference for intravenous versus ORT (P < .001), need for additional training of support staff to implement ORT (P < .01), and likelihood of reimbursement for intravenous versus ORT (P = .07). Notably, degree of importance of ORT was not associated with physician ORT knowledge.
  
  
  CONCLUSIONS
  Efforts to improve use of ORT should be expanded beyond physician education and focus on such barriers as support staff limitations and financial constraints.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: E C
authors.initials: EC
authors.lastname: Reis
authors.forename: J G
authors.initials: JG
authors.lastname: Goepp
authors.forename: S
authors.initials: S
authors.lastname: Katz
authors.forename: M
authors.initials: M
authors.lastname: Santosham
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000209:etiology / Q000628:therapy; D003967:Diarrhea / Q000150:complications / Q000628:therapy*; D005440:Fluid Therapy / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010372:Pediatrics / Q000193:education; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014481:United States