title: Oral rehydration solution for acute diarrhea prevents subsequent unscheduled follow-up visits.
abstract: 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.
  
  
  METHODS
  Randomized, controlled clinical trial.
  
  
  METHODS
  Seven health centers of a large health maintenance organization.
  
  
  METHODS
  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).
  
  
  METHODS
  Prescription for 2 quarts of ORS filled for free at on-site pharmacy plus written instructions versus written instructions alone.
  
  
  METHODS
  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.
authors.affiliation: Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA. duggan_c@a1.tch.harvard.edu
authors.forename: C
authors.initials: C
authors.lastname: Duggan
authors.forename: J
authors.initials: J
authors.lastname: Lasche
authors.forename: M
authors.initials: M
authors.lastname: McCarty
authors.forename: K
authors.initials: K
authors.lastname: Mitchell
authors.forename: R
authors.initials: R
authors.lastname: Dershewitz
authors.forename: S J
authors.initials: SJ
authors.lastname: Lerman
authors.forename: M
authors.initials: M
authors.lastname: Higham
authors.forename: A
authors.initials: A
authors.lastname: Radzevich
authors.forename: R E
authors.initials: RE
authors.lastname: Kleinman
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D002675:Child, Preschool; D003967:Diarrhea / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009819:Office Visits; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome