Patient-centric harm reduction healthcare approach is the need of the hour to improve health outcomes

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Healthcare practitioners should consider variability in every individual to tailor treatment plans accordingly

New Delhi, 7 December 2018: Research indicates that in India, out-of-pocket expenses make up for most of the health financing mix, in turn driving catastrophic expenditure for individuals. This results in a significant economic burden on marginal sections of the population further creating barriers to appropriate health seeking behavior. Harm reduction is gaining popularity as a public health strategy to reduce the potential risks associated with health behaviors.

The need of the hour is to adopt a patient-centered and harm reduction approach to treatment in India. The concept of “Individualization” — inherent in the science of homeopathy — recognizes every patient to be different from the other, even if they have the same disease and individualizes treatment for every person.

Speaking about this at the 4th Edition of The Healthcare Summit organized by Mail Today at The Lalit, New Delhi, Padma Shri Awardee, Dr KK Aggarwal, President, Heart Care Foundation of Infdia said, “The modern system of medicine is also now shifting towards person-centric medicine. Every patient must be managed differently for the best possible outcome. What is acceptable to one patient, may not be acceptable to the other. Treatment must be tailored to each individual patient taking into consideration their individual characteristics, culture, personal preferences, expectations etc. The social determinants of health including the patient’s social situation, environmental factors that influence the health of a person, etc. are also different. Their personal and family history including medical history are different. Individual response to drugs may vary, the side effects may vary. Patients not willing for quiting high risk behaviors may like to shift to less harmful ones. All these variables need to be taken into account when formulating a treatment plan.”

The Institute of Medicine (IOM) has defined patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” Other eminent specialists including Dr Mahesh Verma, Dr Nand Kumar,; Dr V C Khilnani, and Dr Deepali Bhardwaj also presented their views at the summit.

Adding further, Dr Aggarwal, said, “Given the heterogeneity of individuals, the standard treatment guidelines also need to be challenged. Guidelines are evidence-based recommendations for groups of patients, but not the individual patient. While they give a direction, they cannot be applied to all patients alike. Doctors must exercise clinical judgement in selecting the best treatment option for a particular patient. Individualized treatment plans are based on the unique demands of a patient and address his/her needs. They also involve the patient and encourage shared decision making with the patient and the family.”

The core principles of Universal Health Coverage.

• Accessibility: All patients have the right to access the healthcare they need and when they need it.

• Patient-centeredness and equity: All people, regardless of disease or condition; age, gender, race or ethnic background; sexual orientation; geographic location; socio-cultural background, economic or legal status, must have fair and impartial access to quality healthcare.

• Choice and empowerment: All patients have the right to know about the healthcare services that are available. Patients must be able to be meaningfully involved in healthcare decision-making in a variety of ways at the local, national, regional and global level.

• Quality: It is not enough for all patients to have access to healthcare. Provision needs to be safe, of the highest attainable standard and include a commitment to learning and improvement. Patients need to define what constitutes quality in healthcare.

• Partnership and collaboration: Patients have a moral and ethical right to play a meaningful role at all levels; in health and in other areas that can have an impact on health and wellbeing.

• Sustainability and the value of healthcare: All stakeholders need to recognize the value of healthcare when considering investing in universal health coverage.

• Accountability and transparency: Accountability and transparency are vital to delivering safe, effective and affordable healthcare. All stakeholders need to be held accountable on commitments they have made to implement universal health coverage and be accountable to the patients that they serve.

Air pollution cutting life expectancy manifold in India

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Planning, coordination and public cooperation are the need of the hour

New Delhi, 23 November 2018: Air pollution, caused largely by burning fossil fuels, is cutting global life expectancy by an average of 1.8 years per person, making it the world’s top killer, indicates recent research. The tiny particles ingested from polluted air shorten life more than first-hand cigarette smoke, which can reduce it by 1.6 years, and are more dangerous than other public health threats such as war and HIV/AIDS.

Only a handful of India’s 100 most polluted cities have drawn up plans to combat air pollution despite being asked to do so three years ago, a report from the World Health Organization indicated earlier this year.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Several air pollutants can impact health including nitrogen oxide, carbon monoxide, and ozone. However, the classification is done as PM2.5 (particles smaller than 2.5 microns)and PM 10 (particles that are 10 microns). The smaller PM2.5 particles come from sources like open flames and diesel exhaust. They linger for a longer time in the air and can get deep inside the lungs than the larger particles. This therefore should be a higher priority. Cookstoves, heating fuel, and kerosene lighting are other sources of pollution in big cities. There need to be stringent standards for enforcement of regulations for car exhausts, crop burning, or dust from construction sites.”

PM1, PM2.5 and PM10 are risk factors of all-cause, cardiovascular, stroke, respiratory, and COPD mortality. PM1 accounts for the vast majority of short-term PM2.5- and PM10-induced mortality. Smaller size fractions of PM have a more toxic mortality impact.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Delhi has been experiencing high air pollution levels since the past few days. The air quality is particularly poor in the early morning when pollution is extremely high. This is also the time when many people venture out to exercise or drop their school children. It is imperative to use a mask and also make people aware of the harmful effects of air pollution.”

Some tips from HCFI

  • Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days.
  • Avoid exertion in conditions of smog. It is better to avoid walking during smog hours.
  • Drive slowly during smog hours.
  • Heart patients should stop their early morning walk during smog hours.
  • Remember to take the flu pneumonia vaccine.
  • Keep doors and windows shut particularly during the early morning hours.
  • It is better to wear protective masks if you must venture out.

Public cooperation is an absolute imperative to reduce air pollution and its effects

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Protocols set for larger good must be followed

New Delhi, 11th November 2018: Air pollution levels in the capital city of New Delhi turned hazardous the night after Diwali despite Supreme Court’s efforts to curb the bursting of crackers. Some of the major monuments such as India Gate and Red Fort were covered in toxic haze and visibility on major roads was reduced to barely 50 metres (160 feet). Early morning ambient air quality readings touched 526, according to the US embassy in the city which independently monitors pollution levels.

Air quality readings above 500 are considered extremely serious and can aggravate heart and lung diseases. It is advisable to avoid any outdoor activity. Delhi’s air quality typically worsens in winter, due to pollution from the burning of rice stubble, diesel engines, coal-fired power plants and industrial emissions.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Smog is a complex mixture formed by various pollutants such as nitrogen oxides and dust particles, which interact with sunlight to form ground-level ozone, leading to the build-up of haze that hangs in industrial cities. This is a high-alert situation for the city with children and older adults at high risk. Those with lung disorders and breathing issues are also highly vulnerable to the ill effects of this condition. Air pollution is responsible for 3,000 premature deaths in Delhi every year which works out to 8 deaths a day. Also, one in three Delhi kids has reduced lung function and high propensity for increased pulmonary hemorrhage due to the high pollution levels. It is recommended to take precautions for the next few days by staying indoors and not venturing out for exercises or walks.”

Short-term particulate exposure contributed to acute coronary events (heart attack) in patients with underlying coronary artery disease. PM1, PM2.5 and PM10 are risk factors of all-cause, cardiovascular, stroke, respiratory, and COPD mortality. PM1 accounts for the vast majority of short-term PM2.5- and PM10-induced mortality. Smaller size fractions of PM have a more toxic mortality impact.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Delhi has been experiencing high air pollution levels since the past few days. The air quality is particularly poor in the early morning when pollution is extremely high. This is also the time when many people venture out to exercise or drop their school children. It is imperative to use a mask and also make people aware of the harmful effects of air pollution.”

Some tips from HCFI

  • Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days.
  • Avoid exertion in conditions of smog. It is better to avoid walking during smog hours.
  • Drive slowly during smog hours.
  • Heart patients should stop their early morning walk during smog hours.
  • Remember to take the flu pneumonia vaccine.
  • Keep doors and windows shut particularly during the early morning hours.
  • It is better to wear protective masks if you must venture out.

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