Closing the Knowledge Gap: How Understanding Patients' Treatment Preferences Can Save Half a Million Lives

Monday - March 18 2024, 16:27 UTC - 8 months ago

A new study published in Science suggests that understanding and addressing patients' treatment preferences could help save half a million lives a year and reduce unnecessary use of antibiotics. Despite the recommendation of the World Health Organization, many healthcare providers in developing nations do not prescribe oral rehydration salts (ORS) for diarrheal diseases. The study found three contributing factors: lack of knowledge on the effectiveness of ORS, pressure from patients for antibiotics, and stockouts of ORS in healthcare facilities.

Medical professionals in developing nations are aware that oral rehydration salts (ORS), a cost-effective treatment, can save lives by treating diarrheal diseases, which are among the top causes of mortality for children globally. Despite this, few prescribe it.

A new study published in Science suggests that closing the knowledge gap between what treatments healthcare providers think patients want and what treatments patients really want could help save half a million lives a year and reduce unnecessary use of antibiotics.

"Even when children seek care from a health care provider for their diarrhea, as most do, they often do not receive ORS, which costs only a few cents and has been recommended by the World Health Organization for decades," said Neeraj Sood, senior author of the study, a senior fellow at the USC Schaeffer Center for Health Policy & Economics and a professor at the USC Price School of Public Policy.

"This issue has puzzled experts for decades, and we wanted to get to the bottom of it," said Sood, who also holds joint appointments at the Keck School of Medicine of USC and the USC Marshall School of Business.

There are several popular explanations for the underprescription of ORS in India, which accounts for the most cases of child diarrhea of any country in the world: .

1. Lack of knowledge by healthcare providers on the effectiveness of ORS as a treatment option.

2. Pressure from patients for antibiotic prescriptions due to a misconception that antibiotics are more effective.

3. Stockouts, or a lack of availability, of ORS in healthcare facilities.

To test these three hypotheses, Sood and his colleagues enrolled over 2,000 healthcare providers across 253 medium-size towns in the Indian states of Karnataka and Bihar. The researchers selected states with vastly different socioeconomic demographics and varied access to health care to ensure the results were representative of a broad population. Bihar is one of the poorest states in India with below-average ORS use, while Karnataka has above-average per capita income and above-average ORS use.

The researchers then hired staff who were trained to act as patients or caretakers. These "standardized patients" were given scripts to use in unannounced visits to doctors' offices where they would present a case of viral diarrhea - for which antibiotics are not appropriate - in their 2-year-old child. (For ethical considerations, children did not attend these visits.) The standardized patients made approximately 2,000 visits in total.

Providers were randomly assigned to patient visits where patients expressed a preference for ORS, a preference for antibiotics, or no treatment preference. During the visits, patients indicated their preference by showing the healthcare provider a photo of an ORS packet or antibiotics. The set of patients with no treatment preference simply asked the physician for a recommendation.

To control for profit-motivated prescribing, some of the standardized patients assigned as having no treatment preference informed the provider that they would purchase medicine elsewhere. Additionally, to estimate the effect of stockouts, the study's patient actors sometimes carried sachets of ORS or antibiotics, then "realized" it was empty, so on certain visits they indicated they were unable to find treatment elsewhere.