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Healthcare Delivery

Can pharmacists reduce the disease burden of doctors?

The following is a guest post by Pharmacists and Medical Expert Katta Anand Srinivas

Problem: There is one doctor for every 1,445 Indians as per the country’s current population estimate of 135 crore, which is lower than the WHO’s prescribed norm of one doctor for 1,000 people. This is a known stat and this problem has been highlighted over and over again. My attempt with this writeup is to highlight if we can manage our existing talent resources of Pharmacists (PharmD graduates or Post-graduates / Doctorate in Pharmacology only) professionals to reduce the burden on Physicians.

Facts: Before going into the details of how Pharmacists can contribute to the subject under discussion, it is worthwhile to look at the current health status of Indians in workforce.

  • Lifestyle diseases are hitting India where it hurts — its workforce
  • Over 61 per cent of all deaths in India are due to lifestyle.
  • 33% of the population above 30 are suffering from one or more lifestyle diseases.
  • Every 12th Indian a diabetic — India ranks second in the list of countries with highest diabetes patients.
  • Nearly 26% of deaths in India are caused due to heart ailments.
  • The number of overweight and obese people in India doubled.
  • 42.5% of corporate employees suffer from depression
  • 52 per cent of corporate employees are afflicted to lifestyle diseases
  • lifestyle habits of employees result in productivity loss worth Rs 24,000 crore to the IT sector in Bengaluru every year which is around 7% of the IT sector’s total revenue in the city.
  • Employees in the age group of 30-40 years of age contributes to highest share which is 42 per cent of total cost to IT sector due to productivity loss.
  • 23% of women and 19% of men in the workforce are obese.

Discussion: This lifestyle diseases are mostly caused in the younger population due to Metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These

conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

High Blood Pressure: White coat hypertension is a condition affecting patients whoexperience stress or anxiety at a medical setting such as doctor’s office or hospital. This results in a higher than normal blood pressure reading during their visit. White coat hypertension is reported to occur in as many as 25 per cent of the population, increasing the risk of misdiagnosis.

Undiagnosed Hypertension: As per one of the study 10.1 % among the study population were not even aware that they have hypertension until they observe symptoms related to heart disease, makes the scenario rather grim. When left undetected, hypertension can cause damage to the cardiovascular system and internal organs, such as the kidneys.

Globally, 51% of stroke (cerebrovascular disease) and 45% of ischaemic heart disease deaths are attributable to high systolic blood pressure. At any given age, the risk of dying from high blood pressure in low- and middle-income countries is more than double that in high-income countries.

A patient might visit a doctor’s office maybe twice a year or sometimes only when they are sick, unlike their visit to their local chemist. Chemist / Medical stores are visited by the patients at least 3-4 times a month for buying prescription medicines, OTC, Diapers, Feminine hygiene, cosmetics and patients might see the pharmacist / pharmacy when they pass by, as they reside in the same community. This increases the comfort level and reduces the anxiety hence less chances of white coat hypertension. Additionally, hypertension screening at the local chemist shop as they are frequently visited by people (above the age of 30) for minor ailments like diarrhoea, headache, muscle sprain, band aid, vomiting thus reducing the cases of undiagnosed hypertension.

Diabetes Mellitus (“diabetes”) is one of the fastest growing chronic diseasesworldwide, and is associated with significant morbidity, mortality, and health care costs. Diabetes is characterized by high levels of glucose in the blood (hyperglycaemia).

The statistics related to diabetes mellitus globally are alarming. The International Diabetes Federation (IDF) Diabetes Atlas, Seventh Edition, 2015, provides the following estimates: one in 11 adults have diabetes (416 million), nearly half (46.5%)

of adults with diabetes are undiagnosed, and a person dies from diabetes every 6 seconds.

Adults with diabetes have a two- to threefold increased risk of suffering a heart attack or stroke compared to those without diabetes. The microvascular complications of diabetes mellitus make it the leading cause of preventable blindness (Diabetic Retinopathy), renal disease (Diabetic Retinopathy), and amputation (Peripheral Neuropathy and vascular disease) in developed countries.

Diabetes has widespread effects, for every 4 people who have Type 2 DM, about one is undiagnosed. Some of the factors that put a person at risk for diabetes include a family history of the disease, obesity, physical inactivity, high blood pressure, and high cholesterol.

Pharmacists are in a prime position to identify these and other risk factors in patients. Routine and simple tests such as blood glucose testing conducted at health fairs and wellness clinics at pharmacies across the country are an example of how a simple test conducted in the pharmacy or by the pharmacy team may provide an efficient method for identifying a patient with a potential diagnosis and help direct them to appropriate medical attention.

For those who are diagnosed, pharmacists can provide counselling about monitoring glucose levels and how to manage out-of-range levels, including developing an action plan for what to do for hypoglycaemic episodes. Pharmacists can counsel on an appropriate diet and exercise routine to compliment medication management in treating diabetes. This can be especially useful in underserved areas where access to nutritionists or dieticians may be unavailable.

The number of treatment options for diabetes has increased substantially over the past few years, and pharmacists are best positioned to help patients understand the fundamentals and intricacies regarding the medication. For patients requiring insulin, the pharmacist can help instruct the patient on how to administer the medication, as well as answer common questions and concerns.

Community pharmacists are the most accessible health care professionals, as no appointments are required to see them, and to have the highest level of patient contact. Pharmacists are key players in the betterment of patients’ health, not just in terms of screening but in the lifelong management of the disease.

Lifestyle Modifications: it is reported that being overweight or obese contributessignificantly to the burden of diabetes (44%), ischemic heart disease (23%), and certain cancers (range 7%–41%). Yet, obesity is preventable, and strategies to prevent diabetes and cardiovascular disease both include the common goal to optimize peoples’ weight through diet and exercise.

Obesity is currently a worldwide pandemic. Of the world’s population, an estimated 35% of adults are overweight – defined by the World Health Organization (WHO) as a body mass index (BMI) of ≥25 kg/m2. Globally, an estimated 12% of adults are obese (BMI ≥30 kg/m2), half of whom live within just a handful of countries, including the United States of America, People’s Republic of China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia.

The rise in obesity can be attributed to multiple factors, most notably modern lifestyles, which allow for easy access to inexpensive unhealthy foods, sedentary lifestyle, and environmental factors that limit access to healthy diet and exercise management. Effective management of the obesity pandemic requires the promotion and fundamental acceptance of healthy lifestyle habits, which in turn depend upon the availability of resources such as affordable nutritious food options and access to venues that promote exercise. In addition, counselling and guidance by health care professionals is necessary for disease state prevention and treatment. The WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases outlines several objectives to be attained by 2020, including increasing physical activity; decreasing the risk of premature mortality from cardiovascular disease, cancer, diabetes, and chronic respiratory diseases; and halting the rise in diabetes and obesity.

Pharmacists were well suited to delivering weight management services, especially given their regular contact with patients. Participants felt that pharmacists were already well trained to perform basic physical assessments such as weight, waist circumference, blood glucose monitoring, and pharmacotherapy counseling, while additional training could be easily obtained for services that would encompass dietary counseling, guidance on physical activity, and behavioral counseling. Programs that have been developed exist either within community pharmacies alone or as part of collaborative agreements between pharmacists, physicians, and other health care providers. Pharmacists have demonstrated that they can improve drug therapy for patients through medication therapy management (MTM) for chronic diseases such as hypertension, diabetes, and dyslipidemia. Increasing the awareness and knowledge of lifestyle modification strategies may help pharmacists implement more comprehensive MTM services.

Other Areas: A Pharmacists goes through a gamut of questions in his everyday work. They can range from which medication to use for a rash, which is a preferred diabetic meter, demonstrating an asthmatic patient as to how to use an inhaler. An elderly gentleman who came to pick up his blood thinner medication wanted to know which foods he needs to avoid when he is on this medication and a teenager required insights from the pharmacist on which acne cream needs to be used. There was also a concerned mother of a 5 yr old boy who needed recommendation of which medication she can use for her son’s diarrhoea and vomiting. Pharmacists can be a valuable resource of smoking cessation.

Conclusion / Summary: Pharmacy is a profession that is expanding beyond the traditional compounding and dispensing of medication towards a more professional advisory and primary health care role. They are an integral part of the community and serve as an important source of knowledge. Pharmacists are dynamic, patient-centric professionals committed to fulfilling the health care requirements of their patients and they would serve in reducing the burden of our Doctors for treating minor ailments, answer queries related to medicine and medical devices and also provide guidance in disease management.

About the Author

Katta Anand Srinivas is a Pharmacologist, Clinical Pharmacist, Medication Counsellor, Marathoner, and Yoga Practitioner. He has received his MS in Pharmacology from the University of Toledo, Ohio, USA. He is a licensed pharmacist in Washington State and North Carolina, USA and a
a certified reviewer of Elderly Medications from American Pharmacists Association, USA. Anand also runs a website http://www.askyourpharmacist.in.

You can contact Anand at contact@askyourpharmacist.in

References:

  1. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/white-coat-hypertension/faq-20057792
  1. https://www.business-standard.com/article/pti-stories/doctor-patient-ratio-in-india-less-than-who-prescribed-norm-of-1-1000-govt-119111901421_1.html

https://www.medbroadcast.com/channel/medications-and-your-health/how-your-pharmacist-can-help/the-role-of-a-pharmacist

Categories
Healthcare Delivery

How Vitamin D Deficiency could be silently killing you

In 2014 my wife decided to hire a trainer to help her with her fitness. I was curious how this would work and hence I also decided to go with the same trainer. I spoke to the trainer from the Chennai airport where I was on that day on a business trip and then processed to hire her.

I am no stranger to workouts and I had been leveraging trainers before in the various gyms that I had visited. But this was different. As my training started the first thing I remember was that there was intense pain in my muscles and joints. Despite pain killers, the pain would not go away. The trainer kept telling me that it was a matter of time and things would improve. She even brought in another trainer, who helped me with some stretching exercises and twisting. But when things got worse I had to consult my family physician. One look at me, he said, well my friend when was the last time you checked your Vitamin D levels? That started a quest for settling my Vitamin D levels which continues till this day.

Vitamin D Deficiency Symptoms
D vitamin is known since it is produced by the exposure to sunlight light. It is an important element that a human body requires. Deficiency is a critical problem. The below mentioned are a number of the common signs of lack of D vitamin. Vitamin and mineral basic’s consumption is critical for a human body to work. There is a lot of information what’re the sources of these nutrients and concerning the significance of the nutrients.  

In 2010, the venerable Institute of Medicine (IOM) issued a report based on a lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently, a level below 20 was considered a vitamin D deficiency. (Source:
https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893 )

Below are the charts I have kept for my Vitamin D Levels. As you can see I started with a deficiency around 11 and now have managed to keep myself above the 20 mark for the last 5 years.

Key Symptoms

Weakness and Pain: The weakness of bones and muscles is the first sign that there might be a problem. Rickets in children and Osteomyelitis in adults are among the largest of deficiency of D vitamin deficiency symptoms. Weak bones are vitamin d.’s feature However they generally occur at an early age or older age.

Obesity: individuals who’re obese are more common in showing that the signs of lack of D vitamin. Now, this could be one of the reasons for the obesity epidemic in India.

Feeling Low: Difficult to explain but lack of sunlight is known to cause subclinical depression. This often leads to mood swings, lethargy among others

Other Symptoms: Some other signs are knock-kneed appearance, low blood calcium level, high blood pressure level, reasons why that the vitamin d deficiency occurs are given below.

Reasons for Deficiency

The numerous reasons why that the vitamin d deficiency occurs are given below.

  1. Less exposure to direct sunlight
  2. Extensive use of sunblocks and sunscreen
  3. Lack of absorbing of D vitamin.
  4. Hereditary factors

The given are a number of the readily recognize able signs of vitamin D deficiency symptoms. So what do you do?? In my opinion these should be your next steps.

  1. Visit a doctor- Please do not self medicate, please do visit a doctor
  2. Check your Vitamin D Levels regularly from a NABL certified Lab
  3. Plan for at least 30 minutes of outdoor activity daily specially in the morning- Walks, Jogs or just stretching in the park is a good idea.
  4. Keep a record of your levels

I trust this article is helpful in understanding your symptoms and seeking the right help. As always we are open to your questions and we will do our best to answer them.

Categories
Healthcare Delivery

What Indian Healthcare system needs is empathy

Often physicians and doctors are seen as top professional who do what they do and make you better. But does the healthcare system needs more empathy ? I am often go back to the memories of the last days of my grandfather. He was 85 plus and struggling with his kidneys. He was finally admitted to the AIIMS in Delhi.

Categories
Healthcare Delivery

Does India need better patient education ?

Motherhood is perhaps the most challenging phase in a woman’s life – not just because of the of physical changes she experiences, but also due to the wide range of advise she is subject to from family, friends, and the medical practitioners she consults. While advise on motherhood and parenting by friends and family members is often based on that individual’s personal experience (or that of his/her close relative), one would expect that medical practitioners would provide appropriate advise relevant to the patient’s life style, mental and physical health, and monetary compulsions. Sadly, my experience indicates otherwise.

Categories
Healthcare Delivery

Indian doctors may need to re learn how to write prescriptions

 

imagesThere are two important aspects to a marketing document. The first is the content and the second is the delivery.

When it comes to prescriptions things are no different. There was the all time joke about the doctor’s handwriting, which it seems only a chemist could read. This long standing joke probably starts from medical college hostels, where the seniors make the juniors copy notes. I had to disguise my writing in order to get away from fag work when I was in the hostel at Manipal. Now this aspect is the delivery in a marketing context.

(Image Source: Pharmacy Clipart)