- In the last ten years, the face of chronic disease management across the world has been changing. These changes have been focused on increasing the role of the patient in staying healthy whilst living with a long-term ailment.
Cameron C. Taylor argues in Eight Attributes of Great Achievers that “we have within us the power to choose how we respond to a hurtful situation. We cannot control the actions of others, but we can control how we will respond. As we understand our power to choose, we see that we are in control. Our life is not a result of our environment or upbringing, but a result of our choices. We have the ability to determine the kind of life we want to live and the type of person we wish to be.”
It is inevitable that new models of healthcare delivery will emerge post this pandemic. This is because, the challenges we faced post lockdown and during the gradual easing of restrictions have exposed gaps in healthcare that hitherto were not apparent. For many living with chronic diseases, choices have had to be made on whether to attend outpatient appointments for routine check-ups or to forgo them due to concerns around contracting COVID-19. Evidence indicates that locally, a significant number of people opted to stay away.
In the last ten years, the face of chronic disease management across the world has been changing. These changes have been focused on increasing the role of the patient in staying healthy whilst living with a long-term ailment. Research shows that the healthcare cost of chronic disease management is much lower if patients are kept healthy for as long as possible. To achieve this low cost, actions such as the early diagnosis of these diseases, education of the patient on their disease and outcomes if managed appropriately, routine checks to ensure that patients’ disease is well controlled and the concordance of patients with prescribed medication need to happen.
A look at Ghana’s changing disease burden points to the fact that the mortality and morbidity toll from diseases such as diabetes and hypertension is only going to increase. This view is further buttressed by the fact that as at the end of 2019, 59.54% of the population were between the ages of 15 years and 64 years; the age bracket within which most chronic diseases occur. Currently, of the ten leading causes of premature deaths in Ghana, four (coronary heart disease, stroke, diabetes and liver disease) are chronic manifestations.
Globally, during this pandemic, it has been established that whilst outpatient attendances have been declining, there is anecdotal evidence that patronage at pharmacies has been on the increase. In countries where pharmacy practise has evolved with the times, this has come in handy as far as chronic disease management is concerned. This is because community pharmacies are now equipped to undertake many tests e.g. cholesterol testing. Adding on to this is the fact that most have the capability of monitoring blood pressure and pulse rate and blood oxygen levels etc. In the United Kingdom, for example, community pharmacy teams were singled out for praise when many doctors surgeries had to close down at the height of the pandemic but they stayed open.
In Ghana, however, many do not see the community pharmacy as a point of call for such new services. Most people are more aware of the traditional roles of pharmacies and pharmacists in the dispensing of medicines and the management of minor ailments. This to us is a missed opportunity as in reality, the most valuable service that any pharmacist or their team provides is healthcare advice. Our view is that if utilised properly, community pharmacies can provide several services that may help in improving citizens wellbeing and decrease the pressure on our health system.
One major contribution pharmacy can make is the provision of diabetes management where stabilised patients could have their blood sugar levels and medications routinely monitored. This would ensure that patients whose sugar levels are not under control or who may be having side effects from their prescribed medication are identified early. At these appointments, other issues about the diabetic’s well being such as foot care could also be discussed. The patient’s understanding of their medications, how and when they should be taken could also be explored and further information provided if need be. Elsewhere, such clinics have been shown to cut unplanned hospital appointments in diabetics by over 50%.
Another service that could be of importance is the screening of patients for hypertension and the onward referral of these patients for diagnosis confirmation and treatment initiation. A research paper that pooled data from 33 surveys involving over 110 414 participants of mean age 40 years across sub-Saharan Africa provided some stark revelations. It predicted that the prevalence of hypertension at mean ages of 30, 40, 50, and 60 years were 16%, 26%, 35%, and 44%, respectively, with a pooled prevalence of 30% (95% confidence interval, 27%–34%). This is a clear indication that after the age of 30 years, one in three adults in sub-Saharan Africa will suffer from hypertension. The paper also established that almost half of all these patients (44%) were unaware of their hypertensive status prior to the survey.
Further, it was established that overall, only 18% (95% confidence interval, 14%–22%) of individuals with hypertension were receiving treatment across the studies, and only 7% (95% confidence interval, 5%–8%) had controlled blood pressure. This low level of awareness amongst the middle age population who often patronize pharmacies is a big opportunity for the country to address the current midlife mortality creep.
Though there are many other areas where the versatility of pharmacy teams will come in handy, we cannot help but wonder why in the presence of such glaring evidence we continue to underutilise the community pharmacy. Some have argued that this is a result of a failure of pharmacy as a profession to showcase the range and scope of their ability. They prefer to focus on their profession as a healthcare business. Others have harped on the perennial claim that often pharmacists are absent from their premises. Though we can relate to many of these arguments, we are of the view that the current situation is untenable and ought to change.
For this change to happen, we would have to make hard choices. COVID-19 and its aftermath present pharmacy practice in Ghana the biggest opportunity to evolve to the benefit of all. As Winston Churchill put it, “Never let a good crisis go to waste” We hope this huge opportunity is not left to pass us by.
Featured Image Courtesy of Amherst Vet Hospital
Edited by Winifred Awa
