Barriers to use of oral rehydration therapy

Abstract

Objective: To identify potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners.

Design: Cross-sectional, anonymous, self-administered survey of physicians' ORT knowledge, attitudes, and practice.

Setting: A national continuing medical education conference.

Participants: One hundred four general pediatricians primarily in private practice (66%) who completed training after 1980 (76%).

Measurements and 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.

Conclusion: Efforts to improve use of ORT should be expanded beyond physician education and focus on such barriers as support staff limitations and financial constraints.