The study was conducted in 2012 (June - September) by Duke University, Durham using vignette interviews and unannounced standardised patients (SPs) and has been published only in February 2015 (available online in JAMA Pediatrics)
Diarrhoea treatment has a large know-do gap; practitioners asked diagnostic questions more frequently in vignettes than for SPs. Although only 20.9% of practitioners prescribed treatments that were potentially harmful in the diarrhoea vignettes, 71.9% offered them to SPs (P < .001) (1)
In this study, antibiotics and other not-indicated drugs were prescribed by all providers. Even those who provided the Oral Rehydration therapy included antibiotics in their prescriptions. The scenario such that none of the providers (medical degree holders, traditional medicine practitioners or unqualified persons???(data unavailable clearly) provided the right treatment.
A large segment of rural sector in poor-resource countries like India are catered by such providers. Antibiotic abuse, self medications, poor antibiotic stewardship, poor healthcare infrastructure in the rural areas and poor awareness among the people all could be contributory to this aberrant situation.
A similar study published earlier conducted in Rural Madhya Pradesh had similar findings.(2)
- Why this "know-do" gap ?
- What prevents one from "practicing" what one has learnt ?
- What causes one to deviate in a major way from the accepted practices ?
- Mohanan M, Vera-Hernández M, Das V, et al. The Know-Do Gap in Quality of Health Care for Childhood Diarrhea and Pneumonia in Rural India. JAMA Pediatr. Published online February 16, 2015. doi:10.1001/jamapediatrics.2014.3445. (Link)
- Das J, Holla A, Das V, Mohanan M, Tabak D, Chan B. In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps. Health affairs (Project Hope) 2012;31(12):2774-2784. doi:10.1377/hlthaff.2011.1356. (HTML Full Text) (PDF Full text)