With this thesis of Anouk Weghorst we aimed to optimize the management of children with acute gastroenteritis, as too many of them are unnecessarily sent to the hospital. To prevent dehydration, the general practitioner (GP) can prescribe oral rehydration solution (ORS), but we found that this was only done in 20% of children. An important outcome of this thesis was that a single dose of ondansetron syrup, an antiemetic, administered in primary care, reduced vomiting, improved parental satisfaction and decreased costs by 31,2%. However, ondansetron had no effect on ORS intake, referrals or hospital admissions.
As a result, we looked into factors affecting the home management, including ORS. Clear guidelines were found to be useful for healthcare professionals, while emotions played an important role for parents. Interviews revealed that parents appreciated being heard, understood and reassured by the GP. For home management and scheduling follow-up appointments, it is important to know how long symptoms may last. We found that in 90% of children, vomiting, diarrhea and fever resolved within five days after contacting the GP.
Additionally, the organization of healthcare is crucial for the GP’s policy. Therefore, we compared the healthcare system with another high developed country, Australia. We found that Australia already vaccinates against rotavirus and has adapted regulations: No Jab No Play (no vaccination, no childcare). In the Netherlands accessibility is well regulated: fully financed for children and continuity of care ensured. These differences provide starting point for discussions on optimizing healthcare in both countries.
