A survey on the status of care for patients suffering from non-communicable diseases (NCDs), carried out in the Nairobi metropolitan area, has revealed that healthcare providers face unique constraints in offering holistic support to patients.
Such services include counselling on healthy eating and lifestyle changes, such as regular exercise and weight control. This is despite acknowledgement by the medical fraternity that sedentary lifestyles and unhealthy eating habits are key drivers of the rising incidence of NCDs in Kenya and other developing countries.
Among the reasons given by healthcare providers as to why they do not routinely counsel NCD patients about lifestyle change was that most healthcare givers fear that patients would not follow their advice. The other is that there is no adequate reimbursement for offering these services, and also that healthcare providers lack sufficient time to do so during routine consultation visits.
The NCDs targeted by the survey were high blood pressure, diabetes, obesity, high cholesterol, kidney disease, and cancer.
Another surprising finding is that nearly all (93 per cent) healthcare givers interviewed reported that they always prescribe medication whenever a patient is diagnosed with diabetes, only recommending dietary and lifestyle change as secondary measures. This would appear to contradict the recommended practice by diabetes experts, who only resort to medication when alternative methods of control fail to work, or if the condition is particularly severe.
The Health Coordinator at the Kenya Diabetes Management and Information Centre, Dr Joseph Mwangi, says prescription of medications ought to be the fourth measure after first discussing a diet plan with a diabetic patient, followed by advice about physical exercise and, thirdly, stress management.
“Even if the best drugs are prescribed, they will not be fully effective if the patient is not counselled on the first three crucial intervention measures,” he says, adding that majority of healthcare givers are quick to prescribe medications because they are not specialists in the care of diabetics.
The Head of the Division of NCDs at the Ministry of Health, Dr Joseph Kibachio, is equally concerned about this finding. “This is quite perturbing, considering that lifestyle changes are the cornerstone of prevention and treatment of diabetes and a primary focus on only medication without a corresponding adoption of a healthy diet, physical activity and cessation of alcohol and tobacco produces sub-optimal treatment outcomes for patients with NCDs,” he says.
It also emerged from the survey that patients are largely in charge of their wellness routine in terms of adhering to the right medication schedules since almost all providers (98 per cent) rely on patient self-reporting to assess medication adherence. This is opposed to the use of pill counts by medical practitioners to confirm adherence to prescriptions, a widely used practice globally.
The study, titled Health Care Providers’ Perceptions and Practices Survey Regarding Non-communicable Diseases in Nairobi, was carried out between November 2016 and January 2017 and is the first of its kind in Kenya.
It was commissioned by Nairobi-based strategic communication firm, Apex Porter Novelli (APN). The company, among other areas, carries out health-related behaviour change communication. Respondents included general physicians, nurses and specialist practitioners, among them paediatricians, obstetricians and gynaecologists.
“Given the significant influence that health providers have on patient behaviour, the survey sought to provide data about perception and interactions between healthcare givers and patients with regard to NCDs,” observed Lawrence Gikaru, the Managing Director of APN. “We used a 20-year-old research protocol developed by our brand partner, US-based communication company, Porter Novelli, on survey research whose findings provide insights to help bring about public behaviour that can result in widespread desired health outcomes.”
The survey further sought to establish the patient-doctor relationship in the management of NCDs in terms of follow-through. It was motivated by the lack of consolidated data on NCDs in Kenya. The World Health Organisation has reported that NCDs accounted for 26.6 per cent of all deaths in Kenya in 2012.
A total of 315 healthcare givers were interviewed. Only those doctors, clinical officers and nurse practitioners who see at least 10 patients per week qualified for the survey. Majority of the respondents had been in medical practice for 10 years, with half of them under the age of 36. Half of the physicians and specialists interviewed were female.
Another distinctive finding was the very high prevalence of high blood pressure among the population in Nairobi. Some 94 per cent of healthcare providers interviewed reported that they see at least nine cases of the condition every week, out of an average of 86 weekly total patients seen. Hypertension was closely followed by asthma, with 90 per cent of medical practitioners reporting seeing 5.2 patients per week; and diabetes, as 88 per cent reported seeing 5.9 patients weekly.
The survey revealed that three quarters of healthcare providers in private healthcare facilities (88 per cent) and public health facilities (55 per cent) use telemedicine, the delivery of health services through telecommunications infrastructure. Most reported that they use SMS and e-mail to counsel patients and encourage them to adhere to prescriptions.
How the survey was carried out
The research methodology for the survey was quantitative. Data was collected on a face-to-face basis using Computer Aided Personal Interviewing (CAPI). The data collection instrument used was a semi-structured questionnaire with 25 closed and three open-ended questions. Data collection took place in the months of November 2016 and January 2017. At the end of the fieldwork, a sample of 315 respondents was realised against a target of 300.
The writer is a development communication consultant.