The CARE NCD Program – Towards Reducing India’s Disease Burden
‘Non communicable disease’ — a term that is a long-winded non-definition — seems benign and not befitting of a group of diseases that now constitute the world’s largest killer group, accounting for 52% of all deaths worldwide. These include cerebro-cardiovascular diseases like heart attacks and stroke, cancer, chronic respiratory diseases, chronic kidney disease, hypertension, diabetes and psychiatric disorders.
Non communicable diseases (NCDs) might not manifest in the initial stages but can be compared to the boiling frog parable (which is based on the premise that a frog that is put in tepid water and brought to a boil slowly will not perceive the danger and will be cooked to death!). NCDs lead to severe morbidity (usually life-long) and even mortality.
Non communicable diseases affect people in all the socio-economic groups; hence, CARE Hospitals’ NCD program assumes greater significance. The NCD program, the brainchild of Dr N Krishna Reddy, Vice Chairman, is aimed at screening one million individuals in two phases − Phase I: Hospital and Phase II: Community in CARE cluster. Its core objectives are improving outcomes, reducing cost and improving experience by identifying disease, optimizing guidelines based therapy and by keeping the patient engaged.
The NCD clinic was operationalized in April 2017 and provides a spectrum of services, extending from simple screening, assessment, biochemical tests, triage, counseling, consultation, specialist referral based on predefined criteria to longitudinal follow-up and monitoring. The clinic addresses NCDs through prediction, prevention, early detection, education and behavioral modification, within a framework of technology, people, pathways and process.
All men and women in the age group of 30 years and above are screened for NCDs. Screening is driven through an assessment form (taking down an elaborate clinical, social and personal history) and biochemical markers. Emphasis is placed on collecting quality information as the quality of information gathered determines the effect of the care plan. High level stratification is done through risk assessment application, based on the investigations and other data variables captured and aggregated with other physiological data and presented as actionable information.
A personalized care/treatment plan is suggested to the patients, based on detailed screening results/reports, which largely comprises a 10-year risk for Cardiovascular Disease (CVD), Chronic Kidney Disease (CKD), Chronic Obstructive Airways Disease (COAD), cancer, pre-existing disease, newly detected disease, risk factors summary and other vital information, such as BMI, BP, BS diet score and physical activity score. The care plan usually encompasses general health, diet, physical activity, medication, counseling and advice with due emphasis on modifiable risk factors and patient education. Regular follow-up on the phone is done for optimization of the treatment. Patients maintain a close relation with the multidisciplinary team, which changes the game plan where the patient is at the center and not the doctor.
So far around 3,200 persons have been screened under this program, of which 39% were detected to be obese, 34% had CVD risk, 11% diabetes mellitus, 30% were pre-diabetic and 7% had hypertension. The plan is to expand our services with psychologist-assisted lifestyle change through counseling, stress management and cognitive behavioral therapy and IT based decision support systems with features like follow-up screenings, based on clinical guidelines and also flagging for specialist coordination. Much more needs to be done but if we can gear all our services towards engaging and educating more and more of the populace, we will be taking a step in the right direction.
– By Dr Praveen Kumar Pasupulety