Categories
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
Public Health

Covid 19: Reality check for India

By Dr Sumeet Kad

Today, India steps up its battle against Covid-19 by implementing a 12 hours self-imposed curfew across the nation, Many states have already declared the extended lockdown till March 31 and this could continue for even a longer period of time as the new cases keep rising. India’s approach has ranged from screening people at airport arrivals, evacuating citizen from foreign affected areas, shutdown of mass gathering and public places, requesting people with mild symptoms for undergoing self-quarantine and widening the criteria for testing to avoid spreading of community transmission.

But are these steps enough? The more important question being why India didn’t take any proactive steps to boost its healthcare system? India’s dismal health infrastructure can come under severe stress if the cases continue to rise. Clearly, with a bed: population ratio of nearly 1:1000 and less than 100,000 ICU beds, India is hardly prepared to confront this pandemic which can lead to severe consequences. Italy, the US, and China have 3.2, 2.8 and 4.3 hospital beds per 1000 people respectively and they are struggling to handle the coronavirus cases.

With inadequate insurance penetration, India population is largely dependent on public sector hospitals which are severely inadequate. Nearly, 75% of private corporate hospitals are located in less than 40 districts and over 80% of hospitals have less than 30 beds. Infection control, patient management and isolation standards are under severe doubts. There is also a huge deficiency of skilled healthcare professionals adding to the existing woes (doctor-populations ratio of 1:10000 which is way below the WHO norm of 1:1000).

India’s healthcare system is devoid of integrated and inter operable data systems and platforms. This along with non-standardisation and inadequate mobility of health records and data is a vital hurdle in deploying targeted, continuous and connected care. Digital infrastructure needs to be strengthened and monitored regularly. Such technologies can be very effective in isolating and diagnosing positive cases, as shown by state of Kerala.

From pharma side, India is overly dependent on China for bulk drugs or APIs (active pharmaceutical ingredients), around 70% of APIs need of India is catered by China. Now, with China being under indefinite lockdown, India will struggle to produce basic medicines for cancer, malaria, HIV and even antibiotics for its own usage. There is an imminent need to make India a manufacturing hub for APIs. India needs to invest in setting up R&D facilities and provide tax incentives to encourage API manufacturing within the borders.

For these steps to be implemented India needs to increase the budgetary spend on health from current 2% of GDP to 5% in next 5 years. This crisis does provides an opportunity to reflect on the failures and issues within India’s weak healthcare policies. A huge chunk of the government healthcare spending goes into urban-based infrastructure whereas the primary healthcare centers are being neglected since decades.

In this article, I have listed these challenges and measures that need to be taken by India to establish a robust healthcare ecosystem in the coming years. Time is right to evaluate and assess in these trying times and look into the future.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care.

Categories
Healthcare Technology

Healthcare India site is back online !

We are back. We want to take this opportunity to apologize to our readers as the site went down abruptly a few days ago. We were a victim of a cyber attack and as one of the directories on one of the sister sites was affected, the whole site went down. We kept it offline as we continued to conduct advanced diagnosis and eliminate any potential root cause.

Categories
Medical Education Public Health

The challenge of Diabetes in India and how to manage the condition: A detailed analysis

India has been rightly called as the “Diabetes Capital of the World” in recent times. Truly, with more than 50-60 million people suffering from Type-2 diabetes, it is not only an alarming fact that raises a lot of eyebrows but a matter of grave concern for both the healthcare authorities of the country and the nation as a whole.

Though Diabetes Mellitus is one of the most discussed ailments all across the globe but the awareness in India, is relatively low.That is why here an attempt is made to bring to you the most significant facts related to this condition and preventive measures that should be adopted by every diabetic to lead a normal and healthy life.

Categories
Healthcare Delivery

Thoughts on #WorldDiabetesDay

India continues to deal with a unique mix of communicable and non-communicable diseases. As we continue to grapple with communicable diseases in the form of Dengue and Malaria; lifestyle led noncommunicable diseases like Diabetes are also spreading across the country.