Ignite Creation Date:
2024-05-06 @ 4:00 PM
Last Modification Date:
2024-10-26 @ 2:01 PM
Study NCT ID:
NCT04833790
Status:
ACTIVE_NOT_RECRUITING
Last Update Posted:
2024-04-30
First Post:
2021-04-02
Brief Title:
What Drives Poor Care for Child Diarrhea A Standardized Patient Experiment
Sponsor:
RAND
Organization:
RAND
Study Overview
Official Title:
What Drives Poor Care for Child Diarrhea A Standardized Patient Experiment
Status:
ACTIVE_NOT_RECRUITING
Status Verified Date:
2024-04
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Diarrhea is the second leading cause of death for children around the world although nearly all of these deaths could be prevented with an inexpensive and simple treatment oral rehydration salts ORS Many children with diarrhea do not receive ORS when they seek treatment and this study uses a field experiment to examine why this occurs We will use anonymous standardized patients combined with a randomized ORS supply intervention to isolate the causal effect of several potential reasons for why children do not receive ORS when they seek care 1 caretakers prefer ORS alternatives 2 providers have a financial incentives to prescribe ORS alternatives and 3 ORS is often out of stock
Detailed Description:
Diarrhea is the second leading cause of death for children around the world This is true despite the fact that nearly all such deaths could be prevented with a simple and inexpensive solution oral rehydration salts ORS Private health care providers who treat the majority of childhood illness in low- and middle-income countries LMICs are particularly unlikely to dispense ORS to children with diarrhea Instead providers often dispense antibiotics inappropriately Recognizing this significant challenge several international organizations including USAID have invested heavily in trying to increase ORS dispensing in the private sector In the absence of evidence on why ORS is so inconsistently dispensed by private providers however several interventions to promote private sector ORS dispensing have been ineffective Clearly a critical and urgent next step is to examine the key drivers of underprescription of ORS and overprescription of antibiotics in the private sector in order to inform efforts to improve diarrhea care In this study we examine several leading explanations for poor quality of care for child diarrhea in the private sector First patient preferences for ORS alternatives eg an antibiotic could be driving underprescription of ORS We will identify the causal effect of patient preferences Aim 1 by having anonymous standardized patients SPs pose as caretakers of children with diarrhea and express different randomly assigned preferences for treatment ask for ORS ask for antibiotics or let provider decide Second private providers could be responding to financial incentives to sell more profitable alternatives to ORS eg an antibiotic To estimate the causal effect of financial incentives Aim 2 we will instruct a subset of SPs to inform providers that they can get discounted treatments at a relatives drug shop This eliminates the providers financial incentive to recommend a given treatment and allows us to estimate the effect of such incentives Finally private providers might not directly distribute ORS or could have frequent stock-outs To estimate the causal effect of stock-outs Aim 3 we will randomly assign half of the providers to receive a three-month supply of ORS This generates exogenous variation in stock outs and thus enables us to isolate the causal effect of stock outs on ORS and antibiotic prescribing Combining a causal estimates of the impact of each factor on prescribing and b population estimates of the prevalence of each factor will allow us to estimate the population level impact of implementing interventions that address each factor Aim 4 This study will provide the most comprehensive evidence to date on why one of the most important health technologies in history is often not prescribed The results will inform the design of interventions aimed at increasing ORS dispensing and reducing antibiotic dispensing If such interventions are targeted appropriately millions of young lives could be saved
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None