Medics must play bigger role in management of NCDs

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We do not have any data on perceptions and interaction of healthcare givers with NCD patients.

What is your reaction regarding the new survey on health workers’ behaviour and perceptions on NCDs?

I think the research is very timely. Other than the National Step-Wise Survey carried out between 2014 and 2015 on WHO guidelines, we do not have any data on perceptions and interaction of healthcare givers with NCD patients.

The survey showed that healthcare providers are quick to prescribe medications to NCD patients before they offer advice about lifestyle changes and diet. What is your view on that?

That to me is an unfortunate paradox. The essential information has been reduced to four key things, namely: cessation of smoking and alcohol use, weight control, and physical exercise. These are what we call non-pharmacological interventions, or, generally, lifestyle changes. This hardly takes more than five minutes. I am also not convinced about the need for additional compensation to share this information because this is part of caregivers’ jobs.

How, in your opinion, should this issue be addressed?

I would recommend that the NCD Division at the Ministry of Health prepare a job aid checklist that should be given to all healthcare workers emphasising the need to prioritise advice on lifestyle change.  In addition, materials written in simple language capturing the lifestyle changes for NCD patients should be supplied for handing out to patients, and be posted online.

Which of the NCDs is the most serious in Kenya?

I would say we are in the midst of a hypertension epidemic. Fifty per cent of adult Kenyans’ hospital admissions are related to high blood pressure and its complications. It is the commonest cause of stroke, heart failure and chronic kidney disease. We are experiencing high levels of both infectious diseases and NCDs, hence a double jeopardy. The other prevalent NCD is diabetes.

The survey showed that health workers in Kenya believe that the responsibility of adhering to recommended treatment belongs to the patient. What is your view?

My view is that it should be a shared responsibility. To give the example of high blood pressure, there is “the rule of three.” Only a third of Kenyans who have high blood pressure know they have it. Out of those who know, only a third control it to the set target. There are three problems associated with this, namely access, attitude and patient education.

Access is related to cost, so some patients are unable to afford prescribed treatment. Since many NCDs do not have symptoms, patients assume that they have been cured after a few months of taking drugs. Given that healthcare givers know about these challenges, they should not make it the sole responsibility of patients to adhere to medications and treatment of NCDs.

According to the survey, most healthcare providers are willing to use telemedicine and more than 75 per cent of those in private hospitals actually do. What is your opinion on that?

I am one of the earliest advocates of use of telemedicine. This is another area where the attitudes of healthcare providers are very critical. In light of the high level of penetration of mobile phones in Kenya, there is no reason why there should not be a consistent effort to send reminder texts to patients to adhere to treatment.

Finally, I would propose that all medical training colleges introduce a common course on NCDs. The University of Nairobi did this with HIV, with considerable success.

Dr Bukachi’s e-mail address is [email protected]

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