Oral rehydration solution for acute diarrhea prevents subsequent unscheduled follow-up visits

Background. Oral rehydration solutions (ORS) for the treatment of acute dia rrhea remain an underutilized therapy in the United States, despite multipl e clinical trials confirming their efficacy and safety. Economic barriers t o their use have been identified. Objective. To determine whether providing ORS to patients at the time of th eir office visit for acute diarrhea can increase ORS utilization and reduce unscheduled follow-up visits. Design. Randomized, controlled clinical trial. Setting. Seven health centers of a large health maintenance organization. Participants. 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 less th an or equal to 7 days). Intervention. Prescription for 2 quarts of ORS filled for free at on-site p harmacy plus written instructions versus written instructions alone. Primary Outcome Measures. Self-reported use of ORS; unscheduled follow-up v isits 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 unsch eduled follow-up care for diarrhea versus 27 (10.9%) of the intervention gr oup subjects (RR: 0.63; 95% CI: 0.40-0.99). Subjects seeking unscheduled fo llow-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 hour s before initial evaluation than those not seeking unscheduled follow-up ca re. Multivariate analysis showed that randomization to the intervention gro up 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 fo r acute diarrhea is associated with a significant increase in ORS use and s ubstantially reduces the need for unscheduled follow-up visits. Health main tenance organizations should consider routine provision of ORS to children presenting with acute diarrhea.