Training of nurse, continuous drug supply will help improve primary care of chronic patients: Study

Training of non-physician health care providers, ensuring continuous drug supply, electronic storage of health records and systematic patient assessment can help in better management of chronic conditions of patients at primary health care settings, according to a recent study.

The study on the effectiveness of a mHealth-Based Electronic Decision Support System for integrated management of chronic conditions in primary care in India was conducted by the Public Health Foundation of India (PHFI), the London School of Hygiene and Tropical Medicine, UK (LSHTM) and the Centre for Chronic Disease Control (CCDC).

The report was presented at the prestigious American Heart Association annual meeting in Chicago on Saturday.

The results of the study were published in the American Heart Association Journal 'Circulation'. This study has key lessons for health systems of India in terms of the management of non-communicable diseases (NCDs) at primary care settings.

Professor Dorairaj Prabhakaran, vice president Research and Policy, PHFI and the principal investigator of the study, said the mWellcare study is an innovative trial evaluating the role of a nurse-led electronic-clinical decision-supported chronic disease care at the primary healthcare level.

Training of health care professionals and ensuring continuous drug supply in the health system were important, according to the study.

"Key lessons from the mWellcare study can contribute to the Indian government's ambitious Ayushman Bharat programme of enhancing the capacity of 1,50,000 health and wellness centres to provide comprehensive primary health care, with a strong focus on prevention and management of NCDs.

"The trial demonstrates the importance of trained non-physician health care providers and allied health professionals. In addition, it emphasizes the integral role of task shifting making provision for an NCD nurse for optimal management of chronic conditions at the PHC level, capacity building of primary care physicians and NCD nurses ensuring a continuous and adequate drug supply," Prabhakaran said.

This trial also demonstrated the feasibility of incorporating electronic decision support and electronic storage of health records for NCD management in primary care, components which are essential for augmenting and building effective primary healthcare centres in the Indian context, he said.

Highlighting the details of the study design, Pablo Perel, Professor of Clinical Epidemiology and the Director Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine (LSHTM), also co-investigator of the study, said it is possible to conduct large and high-quality trials to robustly evaluate ways of improving the care of people with chronic NCDs in low and middle-income countries.

Professor Nikhil Tandon, Professor and Head of the Department of Endocrinology and Metabolism, AIIMS, a key collaborator on the study, said the electronic clinical decision support system combined with the systematic patient assessment and guideline-based management system which ensures follow-up of patients suffering from chronic conditions has demonstrated how an integrated mHealth system can deliver better quality of care to patients.

Trained NCD nurses were introduced as part of the study design in the health system to help monitor, manage and deliver effective healthcare services to patients.

"These results clearly endorse our strategy which combined the use of task-shifting (non-physician health care workers) with innovative technology as an effective system for management of chronic conditions at the community level," Tandon said.

The number of people with diabetes has shown a staggering rise from 26 million in 1990 to 65 million in 2016, he added.