Connect Health Facilities For Continuous Treatment.

Table of Contents

• Research Theme and Sub Challenge
• Research Design & Data Collection
• Respondent Types
• Target Audience Statistics
• Target Audience Unmet Needs
• Key Behavioural Constraints
• Solution Corridor
• Technical or Regulatory Challenge
• Market Demand
• Secondary Research
• Overall Insights

Research Theme and Sub Challenge

Research Design & Data Collection

The Research took mainly a descriptive approach to find out how to provide facilitation services that connects pharmacists, clinics, labs and other service providers in order to coordinate the provision and administration of care which allows continuous treatment for the benefit of patients and care providers.

Respondent Type

Target Audience Statistics

• 2 Focused Group Discussions and Follow Up Interviews

Gender:

Male = 80%

Female = 20%

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Age Distribution:

30- 40 = 30%

>40 = 70%

Sector of Occupation:

Health Sector = 70%

Non-Health Sector = 30%

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Descriptions of the Respondents:

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Health Sector:

• Medical Doctor / Policy Consultant
• Pharmacists,
• Health Insurance Professional,

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Patients:

• Hypertensive
• Diabetic and
• Ulcer Patient.

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Target Audience Statistics

Our research approach of using focus groups and follow up interviews finds support in a similar published work by Laar, A.K., Adler, A.J., Kotoh, A.M. et al. 1

Methods

“A total of 55 informants – comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers – were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent.”

1. Laar, A.K., Adler, A.J., Kotoh, A.M. et al. Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders. BMC Health Serv Res 19, 693 (2019). https://doi.org/10.1186/s12913-019-4571-6

Target Market Identified

• NCD Patients
• Medical & Para Medical Service Providers
• Home Care Givers
• Technology Service Providers
• Data Scientists And Analysts
• Community / Entrepreneurial

Pharmacists

• Insurance Service Providers

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Target Audience Unmet Needs

Medical Doctors:

• Early Detection
• Quality Historical Data
• Patient Bio-data
• Medication History

Health Insurers:

• Quality Data which is easily accessible, retrievable and usable for policy decisions. Only source of data is National Health Insurance.

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Pharmacists :

• Lack of Access to Prescribers or Doctors,
• Patient Economic Challenge
• Non Adherence to Prescribed Medication
• Lack of Knowledge on the Disease or Diagnosis, Resorting to Herbal Medicine

Patient:

• Confidentiality of Data
• Convenient Access to Drugs and Refill
• Lack of Awareness and knowledge of Nature of Disease
• Early Detection, Supervision and Monitoring
• Access to affordable drugs
• Affordable Financing
• Lack of Access to Medical Personnel after consulting room No Support after consulting room (e.g. Reminders about next appointments, to take medicines and encouragement).
• Lack of Empathy from Medical Care Givers

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Key Behavioural or Market Constraint Identified

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• Protection of Patient Privacy
• Protection of Data for all stakeholders.
• Lack of empathy on the part of doctors
• Patients wariness of reach of data sharing
• Lack of knowledge on the part of patients esp on generic medicine, and nature of ailments.
• Lack of Coordination between health care providers
• Insurance Companies don’t coordinate health care
• Frequent changes in doctors pushes patients to alternative care eg. herbal medicine.

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Key Behavioural or Market Constraint Identified

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A number of researchers have identified patient safety risks that may result from poorly designed health IT tools (Harrington et al., 2011; IOM, 2012a; Meeks et al., 2014; Sittig and Singh, 2012; Walker et al., 2008). In recognition of these risks, the 2012 IOM report described the key attributes of safe health IT, including (IOM, 2012a, p. 78):

• Easy retrieval of accurate, timely, and reliable native and imported data;
• A system the user wants to interact with;
• Simple and intuitive data displays;
• Easy navigation;
• Evidence at the point of care to aid decision making;
• Enhancements to workflow, automating mundane tasks, and streamlining work, never increasing physical or cognitive workload

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Source : https://www.nap.edu/read/21794/chapter/7#219

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Solutions Corridor

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• May not be necessary to enlist the whole hospital, but rather focus on the departments that deal with NCDs.
• Serial Number Coding, Biometric Approval, In Patient Access & Approval can help improve data security for stakeholders.
• Education of Patients on nature of NCD, generic vs branded drugs.
• Education of Doctors on Patient-Doctor Relationships, Empathy and Support System
• Health Insurance is a good starting point for data collection, affordability, and access to network of doctors and pharmacists.
• Technology is the game changer but adoption is slow and difficult.
• Financing systems and facilitation
• Affordability
• Current Policy/ Regulations Governing Health Facilities
• Insurance Drawback on Home Visits

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One Policy Advisor and One industry player respondent recommended that the necessary legal requirements are complied with for the use of patient information That requires compliance with the following:

• Patient Data Collection, Sharing and Rightful Use
• Patient Data Protection
• Ghana Data Protection Act 2012
• Data Protection Commission Ghana
• Health Facilities Regulatory Agency
• Patients Charter

Technical Or Regulatory Reasons against the sub-challenge

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The potential of having an integrated health care platform using technology with the identified stakeholders was a shared insight, with stakeholders agreeing on the need to work together.

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Technology is identified as the major enabler for creating access and opportunity for facilitation.

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All Respondents were interested to participate and pay for an integrated platform

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Patients indicated they could pay quarterly (600 GHS) or monthly (200 GHS)

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Market Demand

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Basis for advocating for an integrated approach that offers continuous treatment

“India accounts for more than two-third of mortality due to non-communicable diseases (NCDs) in south-east Asia. The burden is high in Karnataka, one of the largest states in southern India. There is a need for integration of disease prevention, health promotion, treatment and care within the national program at primary level. A public-private partnership initiative explored evidence gaps to inform a health system based, integrated NCD programme across care continuum with a focus on hypertension and diabetes.” - Jayanna, K., Swaroop, N., Kar, A. et al. Designing a comprehensive Non-Communicable Diseases (NCD) programme for hypertension and diabetes at primary health care level: evidence and experience from urban Karnataka, South India. BMC Public Health 19, 409 (2019). https://doi.org/10.1186/s12889-019-6735-z

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Global NCD Stats

Global : Key facts

• Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of all deaths globally.
• Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 85% of these "premature" deaths occur in low- and middle-income countries.
• Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million).
• These 4 groups of diseases account for over 80% of all premature NCD deaths.
• Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD.
• Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs.

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Source : https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

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Global Economic Impact of NCDS

https://www.who.int/nmh/publications/best_buys_summary.pdf

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Projected Global Public Spending on NCDs

https://www.who.int/nmh/publications/best_buys_summary.pdf

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NCD Stats : Ghana

https://www.who.int/nmh/countries/gha_en.pdf?ua=1

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NCD Stats : Ghana

https://www.who.int/nmh/countries/gha_en.pdf?ua=1

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Ministry of Health Integrated Framework for NCD Control in Ghana

Source : Ministry of Health: National Policy for the Prevention and Control of Chronic Non-Communicable Diseases in Ghana

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Some Suggested Approach to Integrated Health Care System

https://www.frontiersin.org/articles/10.3389/fcvm.2019.00076/full

There is a strong advocacy for the use of technology in providing connected health care, even though there is little documented evidence of its effectiveness in low income countries.

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Some Suggested Approach to Integrated Health Care System

https://www.radiusinnovation.com/expertise/connected-health-and-wellness.html

https://www.marsdd.com/news/transforming-health-decentralized-connected-care/

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Some Suggested Approach to Integrated Health Care System

Symphony RM advocates for an AI Backed Health Marketing. Their approach recognises the importance of Data as (stated by Focus Groups).

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Source: https://www.symphonyrm.com/healthcare-marketing-clinicians-and-care-managers-in-the-patient-360-ecosystem/

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Potential of Technology To Support NCD Care

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Integrated Health Care Service Providers : Excelicare (UK)

https://excelicare.com/about-us/overview

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Integrated Health Care Service Providers : Karma Health (Nepal)

An illustration of how patients with chronic non-communicable diseases, like Rambahadur and Haricharan, would receive care in Karma Health’s integrated system comprising of health clinics, community outreach clinics and through community health workers.

https://karmahealth.org/transforming-non-communicable-diseases-care-for-all-5a90a07ca538

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Integrated Health Care Service Providers : Express Med Services (Ghana)

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Integrated Health Care Service Providers : Hewale Health Services (Ghana)

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Integrated Health Care Service Providers : BIMA Insurance

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Quotes from Our Respondents

Unmet Needs

• “Some patients because of roaming around, don’t even know they have picked the same medication…they go to pharmacy A and they get brand A, they go to pharmacy B they get brand B” - (Pharmacist)
• “Doctors hardly follow up on their patients if you don’t go to the hospital” (Diabetic Patient)
• “I have seen about 4 doctors already and done my tests in 3 labs and 6 or more pharmacy shops” (Hypertensive Patient)
• “They hardly explain procedures at the hospital especially the public hospitals…same at the pharmacy” (Diabetic Patient)
• “Sometimes we buy the same medicine, the same drug but they were not kept under proper conditions so they have lost their efficacy” - (Diabetic Patient)

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Quotes from Our Respondents

Unmet Needs

• “Most patients do not know their prescribers” - (Pharmacy Owner)
• “Prescriptions don’t bear prescribers names or contacts to enable pharmacists to communicate with the prescriber if there are any issues with the prescription or any recommendations that you want to give to the prescriber for the benefit of the patient” - (Pharmacy Owner)
• “Prescribers in government hospitals keep on changing” - (Pharmacist)
• “Information from medical doctors is a challenge, sometimes you can’t even understand what exactly they have written on the prescription sheet and they are not available to seek clarification from them” - (Pharmacist)

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Quotes from Our Respondents

Unmet Needs

• “Some patients are not able to afford exactly what the prescriber has given to them ….so knowing the economic background of the patient can help solve this challenge” (Health Insurer)
• “Prescribers should have their name and contact on the prescription form so that they can be readily reached for any clarification” - (Pharmacist)
• “There is a need to have constant communication with doctors” - (Pharmacist)
• “The way they design their prescription forms should be modified…..consulting room phone numbers should be on the prescription” - (Pharmacist)

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Quotes from Our Respondents

Pricing

• “Some want to buy the blood pressure machine/glucose machine to test at home rather than coming to the pharmacy….the cost of the machines are expensive. Only a few are able to afford, especially in the rural and low income areas” - (Pharmacist)
• “Prices of medication can be prohibitive for many of the patients” - (Community Pharmacist)
• “The cost of any integrated system transferred to the patient will make drugs even more expensive” - (Hypertensive Patient)
• “The question i ask myself is when you are old and are not working, would you have the money to purchase that same medication that you have been on the greater part of your adult life” (Hypertensive Patient)

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Quotes from Our Respondents

Behavioural Constraints

• “Some think that once they take the medicine the disease is supposed to go away” - (Pharmacist)
• “There is a non-pharmacological aspect of disease management and this is something many patients long for” -( Community Pharmacist)
• “Sometimes they need rest or counselling” - (Community Pharmacist)
• “It is difficult because they change the routine or timetable of doctors” - (Patient)
• “People don’t use dedicated pharmacists, they scan around…no continuity of care” - (Pharmacist)
• “Occasionally I do forget to take my medication when am busy” (Patient)
• “Taking the medicine can be challenging because if you are taking the medication and you don’t see any improvement in terms of for instance the pressure vanishing” - Patient

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Quotes from Our Respondents

Behavioural Constraints

• “Some have deviated from drugs for a long time” -(Community Pharmacist)
• “Some have shifted from orthodox to herbal…facing the same challenges…by the time they get to the pharmacy their sugar/blood pressure is very high because they have stopped using the orthodox medicine to control the disease” (Community Pharmacist)
• “We try to counsel them….that the orthodox medicines they are taking is a long term management” (Community Pharmacist)
• “When they give them the drugs at the hospital they don’t tell them exactly that the drugs are for the long term and not just the short term” (Community Pharmacist)
• “We don’t know what the patient does at home” (Community Pharmacist)
• “I am a patient but don’t like going to the hospital…” (Hypertensive Patient)

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Quotes from Our Respondents

Technology & Data

• “We need to be sure of what information we want and what information is being recorded at the point of serving each patient” - (Health Insurer)
• “Patient privacy should be of top most importance” - (Ulcer Patient)
• “If patients can sit in the house and access information from pharmacists and prescribers that would be a good thing” (Hypertensive Patient)
• “NHIS has all the data that can help ensure the patient can be managed very well”- (Insurance Policy Advisor / Medical Doctor)
• “You need data before you can move on to what to do….you need validated data, data that gives you real time, that gives you real perspective of what is going on…specific interventions be based in that data” (Insurance Policy Advisor / Medical Doctor)

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Quotes from Our Respondents

Technology & Data

• “May be an app to communicate with prescribers” - (Community Pharmacist)
• “ Almost every pharmacy has a software they use to serve patients but they don’t keep records of their patients properly” (Health Insurer)
• “We don’t keep a proper database in our facilities to help the patients” - (Community Pharmacist)
• “Technology is an enabler for our world today” - (Hypertensive Patient)
• “Can there be softwares that allow people to track their medications” (Hypertensive Patient)
• “Technology is key but adaption is slow when it comes to the healthcare space” (Community Pharmacist)

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Quotes from Our Respondents

Technology & Data

• “Technology is key but adaption is slow when it comes to the healthcare space” - (Community Pharmacist)
• “We have all these technologies but if we don’t involve the patient in the treatment, you won’t get to the goal you want to get to….if your drugs get finished and you don’t know you are supposed to get a refill and you go in for herbal medication too they come back with crisis….so education is the key” - (Hospital/ Entrepreneurial Pharmacist)
• “…..but how about the issue of confidentiality….huge amount of data stored somewhere for easy access and stuff like that” (Policy Advisor/Medical Doctor)

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Quotes from Our Respondents

What can we do to support the patient?

• “A necessary stakeholder becomes the Data Protection Commission because you need a reservoir for all this information” - (Policy Adviser / Medical Doctor)
• “Another stakeholder is the Health Facilities Regulatory Authority” - (Health Insurer)
• “NCDs require a lot more interactions” - (Health Insurer)
• “A structured managed care model is a way out” - (Health Insurer)
• “Fully integrated approach should be the sure way….not only looking at technology but also engagement” (Pharmacist)
• “Do more engagement and collaboration in giving care to patients” - (Patient)
• “Claim management process not done in real time” - (Health Insurer)
• “If you are substituting a drug, it should be recourse to the doctor” (Policy Advisor/ Medical Doctor)

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Quotes from Our Respondents

Your Concluding Remarks :

• “Patients visit different doctors but build a relationship with the community pharmacy” - (Pharmacist)
• “ We should not downplay effectiveness of generics” - (Pharmacist)
• “Patients get a lot of information from pharmacists” - (Pharmacist)
• “NCDs don’t really attack you like other diseases” - (Patient)
• “It is harder to come to terms with conditions that don’t have a start or end period” - (Policy Advisor / Medical Doctor)
• “If the person doesn’t understand or grasp it, it becomes a source of anxiety” - (Pharmacist)
• “They want to hear something definitive, but because you are dealing with a condition that doesn’t have a definitive outcome….it’s harder for the patient to grasp it….harder to accept and move along” - (Pharmacist)
• “The doctor is there for you…you still have the power to discuss and ask”. (Policy Advisor/Medical Doctor)

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Quotes from other published works which support our research

“Unlike the situation with other drugs such as anti-malaria drugs and some antibiotics in pregnancy we prescribe, only doctors give prescription in the case of NCDs. This leads to long waiting and difficulties accessing needed medications.” (Community based CVD nurse) (Laar, A.K., Adler, A.J., Kotoh, A.M. et al. 1)

“For me, my major challenge is that sometimes you are just in need of your BP drugs but you will get to the hospital very early and leave there very late, so to me if they can arrange and group BP patients at one side so that you join that queue and go for your medicine immediately. Perhaps the nurses who counsel us can be permitted to have the medicines so that once in a month when we go to see them they can give us the medicine. That will be simple. Imagine going to join the long queue just for medicine; I prefer to go to the drug store to buy them myself. (A female FGD participant)” (Laar, A.K., Adler, A.J., Kotoh, A.M. et al. 1)

“The quantity of drugs given to patients to take discourages them from adhering for a long time. The sheer number of drugs discouraged them, although it was noted that if you gave patients too few medications they would also complain.” (Laar, A.K., Adler, A.J., Kotoh, A.M. et al. 1)

1. Laar, A.K., Adler, A.J., Kotoh, A.M. et al. Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders. BMC Health Serv Res 19, 693 (2019). https://doi.org/10.1186/s12913-019-4571-6

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Overall Insights From Research

• Among stakeholders interviewed, Quality Validated Data is the most important requirement needed to connect care providers and patients in order to facilitate continuous care.
• Technology is the major enabler for an integrated health care platform.
• Technology is the major enabler for creating access and opportunity for facilitation.
• Financing is a major problem especially for the aged, low income and rural patients.
• More education is required for patients to understand the nature of their disease

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