Misperceptions of healthcare providers has been identified as one of the major reasons why Oral Rehydration Solution (ORS), which could be a live-saving treatment in diarrhoea cases, is not being prescribed in India for children who suffer from diarrhoea, according to a study.
Published in February 2024 in Science Journal, the study is titled ‘What drives poor quality of care for child diarrhoea? Experimental evidence from India’. The study was conducted across 253 medium sized towns (population between 10,000 and 1.5 lakh) in Karnataka and Bihar to explore the reasons for underprescription of ORS in India.
Among the five authors in the study was Arnab Mukherji, chairperson, Post Graduate Programme in Public Policy and Management at Indian Institute of Management - Bangalore (IIMB). The other researchers were from Pardee RAND Graduate School at Santa Monica, Sanford School of Public Policy, Duke University at Durham, and University of Southern California in U.S.A.
“We did our work where there were very few examples of large private hospitals,” said Prof. Mukherji. Most of these providers reported seeing an average of six cases of child diarrhoea every week (about 24 in a month).
More than 2,000 private healthcare providers, including single doctor clinics and nursing homes, were part of the study conducted in 2023. In addition, 25 standardised patients (actors) were trained to present as caretakers of children with diarrhoea. With randomised controlled trials, the researchers tested the effects of three main reasons – misperception of providers, financial incentives and ORS stock – for under prescription of ORS.
Barrier 1 - Misperception
Providers’ misperceptions, which explained 42% of under prescription, stemmed from their confusion about whether patients preferred non-ORS treatments, like antibiotics, the taste of ORS and how it is not perceived as real medicine. While most patients in another household survey conducted by the researchers indicated that they preferred ORS, the providers thought that only 18% of patients preferred the solution.
Hence, when the standardised patients expressed their preference for ORS, the prescription increased by 27 percentage points, the researchers observed.
Barrier 2 - Financial incentives
While prescribing a lucrative treatment option for financial incentives was perceived to be a barrier (5%), the results of the study suggested that eliminating the incentive (by informing the provider that the patient would purchase medicines from a different location), had no effect on prescription of ORS.
Barrier 3 - ORS stock
For the third barrier, whose role was only 6%, half of the providers were randomly assigned to receive a six-week supply of ORS. The elimination of stock-outs resulted in a 7 percentage points increase in ORS provision, and 17 percentage points increase among clinics that sell medicine instead of prescribing it.
Recommendation of researchers
When asked about the interventions that the researchers suggest to tackle the problem of under prescription of ORS, Prof. Mukherji said, “Our research emphasises the importance of provider’s perception of the kind of care a patient’s family is seeking as an important factor in determining prescription behaviour of the provider. To support this, sharing the results of our study with all, and encouraging patients to express their preferences at the point of care, may help alleviate any mistaken patient preferences.”
