What drives poor quality of care for child diarrhea? Experimental evidence from India

Patients' requests and physicians' prescribing behavior. A systematic review

BACKGROUND

Patients' requests is a frequently cited factor in the literature affecting doctors' prescribing decisions. This systematic review aims to consolidate quantitative findings, shedding light on the relationship between patient requests and the actions taken by general practitioners. A broader perspective was adopted by not limiting our investigation to specific medication categories. Instead, we treat the act of requesting as a communicative behavior, separate from the pharmacological context.

METHOD

A comprehensive search across various online databases was performed. Two authors independently contributed the screening phase. The selection of articles and the data extraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart.

RESULTS

Patient's request demonstrated to be a driving factor for physician's prescribing behavior not only when antibiotics are involved, but as a more generalized trend.

CONCLUSIONS

The study acknowledges the complexity of patient-provider communication, emphasizing the asymmetry in roles and the tension between patient empowerment and medical expertise. By uncovering the underlying mechanisms shaping doctors' responses to patient requests, this systematic review enhances our understanding of communication in healthcare settings.

PRACTICE IMPLICATIONS

Understanding the impact of patient requests on prescribing decisions highlights the importance of training healthcare providers in effective communication strategies that balance patient autonomy with clinical judgment. These insights can inform guidelines and interventions aimed at managing patient expectations, supporting more evidence-based prescribing practices and fostering better doctor-patient relationships.

Impact of co-packaging oral rehydration salts and zinc on diarrhoea treatment dispensing behaviour in selected rural health facilities in Zambia

Co-packaged oral rehydration salts (ORS) and zinc for the treatment of childhood diarrhoea was added to the World Health Organization's Essential Medicines List in 2019, to help address the persistently high mortality and morbidity associated with diarrhoea in children under 5 years of age and the low uptake of the recommended co-therapy. However, little empirical evidence exists on how co-packaging impacts dispensing practices in low-resource settings. Here, we present findings from a study conducted in Mongu District, Zambia, aimed at evaluating the effect of introducing a co-pack containing ORS and zinc on dispensing behaviour at rural health facilities. Data from dispensing records were collected before and after the introduction of the co-pack, in 2016 and 2017, respectively, from seven government health facilities. We used multilevel logistic regression to account for the fact that the data is clustered by health facility and to address potential intraclass correlations in dispensing practices within the same facility. The results indicate an overall odds ratio of 8.42 (95% CI: 5.47-12.9) for the dispensing of both ORS and zinc together, for 2017 versus 2016, along with a significant reduction in the variability of dispensing practices between facilities (once the co-pack factor was included). Additionally, the data suggest that less well-resourced facilities experienced the greatest benefit from the introduction of the co-pack. These findings provide valuable insights into the potential of co-packaging to foster appropriate diarrhoea-treatment dispensing practices in resource-limited settings. As such, they provide a foundation for further research to validate them on geographical scales beyond the district level.

Assessing Community Pharmacists' Management of Acute Diarrhea in Saudi Arabia: A Simulated Patient Study

INTRODUCTION

Antimicrobial resistance poses a significant threat to global health, and community pharmacists are positioned to play a crucial role in mitigating this issue. The present study aimed to evaluate the extent of compliance among community pharmacists in Saudi Arabia with relevant regulations and clinical guidelines in the management of suspected infectious diarrhea.

METHOD

This cross-sectional study employed simulated patients presenting with diarrhea to assess the management practices within 200 community pharmacies in two major cities across Saudi Arabia. Trained pharmacy students presented pharmacists with three case scenarios involving adult patients with diarrhea. Statistical analysis included descriptive statistics and chi-square tests to examine the relationships between pharmacist characteristics and practice categories.

RESULTS

The findings of this study indicate that the performance of community pharmacists in managing diarrhea is suboptimal. Notably, less adequate practice emerged as the predominant outcome at 63% (n = 126). Only 14% (n = 28) of pharmacists demonstrated adequate practice, while 23% (n = 46) exhibited poor investigative practice. Metronidazole dispensing increased across scenarios, from 16.92% (n = 11) in Scenario 1 to 30.3% (n = 20) in Scenario 3. Most pharmacists inquired about the patient's age (72%; n = 144); however, only a limited number probed for symptoms of dehydration (5.5%, n = 11) and medication history (3%, n = 6). A significant association was found between geographical location and practice performance (p = 0.015).

CONCLUSIONS

This study reveals significant deficiencies in the management of infection-related diarrhea, underscoring the urgent need for enhanced training and regulatory measures within community pharmacy settings in Saudi Arabia to improve patient care and effectively address antimicrobial resistance (AMR).