Piramal Swasthya runs NCD programs in India to address the growing issues of non-communicable diseases like hypertension, diabetes, and their complications. The program aims to enable early intervention, strengthen public health systems, enhance patient compliance, and provide disease management. Key services include awareness campaigns, screening, disease management through medication and follow-ups, health worker training, and evidence-based personalized care. Between 2013-2015, over 500,000 people were screened in several Indian states, and over 67,000 cases of hypertension and diabetes were diagnosed and managed through the program.
Dia-Bese presentation at Diabetes India World Congress 2015Nitin Jobanputra
This presentation was done by Dr Dgambar Naik MBBS, MD (Medicine), DOIH, DHA, FIAE, FAIMP (Cardiology)
About 3,300 Diabetologist attended this forum and gave enthusiastic response to Diabetes Complication Management supported by algorithm based program to deliver CDSS (Clinical Decision making Support System) tools
A FEASIBILITY STUDY OF REMOTE MONITORING OF CAPD PATIENT’S BLOOD PRESSURE AND
BLOOD GLUCOSE MEASUREMENTS VIA THE INTERNET. G. Pylypchuk, P. Jacobson, C. McAllister
University of Saskatchewan, St. Paul’s Hospital, Saskatoon, Saskatchewan. Regina, Saskatchewan
The purpose of this study was to determine the feasibility of remotely monitoring blood pressure (BP) and
glucose measurements in a cohort of diabetic patients receiving continuous ambulatory peritoneal
dialysis (CAPD).
Dia-Bese presentation at Diabetes India World Congress 2015Nitin Jobanputra
This presentation was done by Dr Dgambar Naik MBBS, MD (Medicine), DOIH, DHA, FIAE, FAIMP (Cardiology)
About 3,300 Diabetologist attended this forum and gave enthusiastic response to Diabetes Complication Management supported by algorithm based program to deliver CDSS (Clinical Decision making Support System) tools
A FEASIBILITY STUDY OF REMOTE MONITORING OF CAPD PATIENT’S BLOOD PRESSURE AND
BLOOD GLUCOSE MEASUREMENTS VIA THE INTERNET. G. Pylypchuk, P. Jacobson, C. McAllister
University of Saskatchewan, St. Paul’s Hospital, Saskatoon, Saskatchewan. Regina, Saskatchewan
The purpose of this study was to determine the feasibility of remotely monitoring blood pressure (BP) and
glucose measurements in a cohort of diabetic patients receiving continuous ambulatory peritoneal
dialysis (CAPD).
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities.
It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events.
Let us see what Pharmacists, Doctors and Patients can do about it.
Transforming End of Life Care in Acute Hospitals PM Workshop 2: NHS Trust Dev...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals PM Workshop 2: NHS Trust Development Authority presented by Jacqueline McKenna, NHS Trust Development Authority
Professional coach Sandra Schiff served as a member of the advisory council of The Senior Alliance in Wayne, Michigan, from 2011 to 2013. The president of Health Mate, Inc., Sandra Schiff continues to provide care transition coaching as a member of the Care Transitions Program®.
National Diabetes Inpatient Audit (NaDIA) 2015Laura Fargher
A easy read summary report about the quality of diabetes care in hospitals in England and Wales. Based on findings from the National Diabetes Inpatient Audit (2015).
Service Innovation - HSJ Finalist; Setting up Poole Alcohol Care and Treatmen...Health Innovation Wessex
Getting to Grips with Alcohol 2016
Presentation Slides
Service Innovation - HSJ Finalist
Setting up the Poole Alcohol Care & Treatment Services
Graeme White
KY HIMSS Leveraging Innovative Ways to Connect with Patients at Covenant Care...PreventScripts
Leveraging Innovative Way to Connect with Patients at Covenant Care Practices- Our experience using a mobile pre-visit assessment, Clinical Decision Support, and remote Monitoring Tools to engage and improve health outcomes in "Rising Risk" patients
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities.
It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events.
Let us see what Pharmacists, Doctors and Patients can do about it.
Transforming End of Life Care in Acute Hospitals PM Workshop 2: NHS Trust Dev...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals PM Workshop 2: NHS Trust Development Authority presented by Jacqueline McKenna, NHS Trust Development Authority
Professional coach Sandra Schiff served as a member of the advisory council of The Senior Alliance in Wayne, Michigan, from 2011 to 2013. The president of Health Mate, Inc., Sandra Schiff continues to provide care transition coaching as a member of the Care Transitions Program®.
National Diabetes Inpatient Audit (NaDIA) 2015Laura Fargher
A easy read summary report about the quality of diabetes care in hospitals in England and Wales. Based on findings from the National Diabetes Inpatient Audit (2015).
Service Innovation - HSJ Finalist; Setting up Poole Alcohol Care and Treatmen...Health Innovation Wessex
Getting to Grips with Alcohol 2016
Presentation Slides
Service Innovation - HSJ Finalist
Setting up the Poole Alcohol Care & Treatment Services
Graeme White
KY HIMSS Leveraging Innovative Ways to Connect with Patients at Covenant Care...PreventScripts
Leveraging Innovative Way to Connect with Patients at Covenant Care Practices- Our experience using a mobile pre-visit assessment, Clinical Decision Support, and remote Monitoring Tools to engage and improve health outcomes in "Rising Risk" patients
El 30 de mayo de 2016 organizamos en la Fundación Ramón Areces un Simposio Internacional sobre 'La oportunidad digital de la sanidad'. En él se analizaron las ventajas que ofrecen las nuevas tecnologías en los nuevos canales asistenciales (teleconsultas, gestión remota de enfermedades crónicas y de salud poblacional, herramientas para el autocuidado). También se vio el impacto que tendrá en este campo la aplicación de la inteligencia artificial, el Internet de las Cosas, el Big Data y la computación en la Nube.
Be There San Diego - Cardiovascular Disease Prevention, a Regional Quality Co...UCLA CTSI
2017 Southern California Dissemination, Implementation and Improvement (DII) Science Symposium
Be There San Diego: Improving Cardiovascular Disease Prevention through a Regional Quality Collaborative
Christine Thorne, MD, MPH - University of California, San Diego
Allen Fremont, MD, PhD - RAND Corporation; UCLA; VA Greater Los Angeles HealthCare System
For more information on DII, go to: https://ctsi.ucla.edu/patients-community/pages/dissemination_implementation_improvement
Screening for diabetes and its complications as part of the Alberta Diabetes ...Kelli Buckreus
2004 (Jan) 3rd National Conference on Diabetes and Aboriginal Peoples, National Aboriginal Diabetes Association (NADA), poster presentation by BRAID Research
2. 1
Hyper-
tension
Diabetes
Type II
At the time of
diagnosis
10+ years post
diagnosis
20+ years post
diagnosis
Heart attack or stroke
Heart failure
Diabetes
Kidney failure
Trouble with memory or
understanding
~10-15% of cases have
Retinopathy
30% have at Year 10 post
T2D Dx
~65% develop Retinopathy;
20% will have PDR/DME
~15% of cases
have Neuropathy
~50% develop the
condition
~60-65% have Neuropathy;
20% develop severe symptoms
Diabetes
Cardio vascular
complications
~20% of diabetics have
Nephropathy
~30% develop the
condition
>50% develop the condition,
12-15% proceed to ESRD
COPD
~60% have HYT &
Dyslipidaemia comorbidity
2-4X risk of CV disease,
to organ damage
High risk of NALFD/
NASH
~30% have Asthma
comorbid
~50% have pulmonary
hypertension
May even lead to CV
complications
Typical Manifestation of NCD’s: An illustration
3. 2
Complexity of Diagnosis & Interventions
For patients
For doctors
Limited awareness on self monitoring and self diagnosis of conditions
- hence dependency on frail lab infrastructure especially in rural areas
Lack of dedicated primary health models that can address Chronic conditions through
early intervention
Heavy dependency on the already stretched tertiary set up
Limited awareness on additional complications resulting from chronic conditions
Non compliance /limited compliance of patients to prescribed drugs and treatment
schedules
Lack of standard guidelines for practitioners to address comorbid conditions
Most patients turn up at escalated complication stages
4. 3
Piramal Swasthya NCD programme objectives
Early intervention to prevent the incidence
S Strengthen Public Health system to tackle NCD
P Patient compliance enhancement
A Awareness - chronic conditions & complications
Disease management to halt progressD
E
5. 4
NCD Service Strategy @ Piramal Swasthya
Preventive Promotive Predictive
Awareness
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
Disease management
C.1 Drug prescription & dispensation
C.2 Specialist consultation
C.3 Referral services
C.4 Follow up & closure
C.5 Periodic diagnosis
Patient segmentation
E.1 Systematic risk
assessment
Screening
B.1 Community screening
B.2 Door to door screening
Health system strengthening
D.1 Training of health out reach
workers
D.2 Partner with Public health system
Evidence based health
F.1 Personalized follow
up
A
B
C
D
E
A
E
B C
D
are independent unit of services. Each of these units when executed independently
or in combination with other units result in an output/outcome with specific
measurement.
Service
combinations
Example Performance Measures Output/Outcome
A.1+B.1+D.1 WDF Assam # of beneficiaries covered
# of awareness campaigns
# of health workers trained
Carried 6 Lac screening
2000+ awareness campaigns
Trained 6000 ASHA and 10000 community health
workers
A+B+C+D+E+F CASALUD,
Mexico
Model created for preventive and
disease management of NCDs
Screened 1.3 mn beneficiaries and averted 25000
beneficiaries from developing the condition
F
F
Conceptualization stage
6. 5
Platform
A. Awareness
& Counselling
B. Screening
&
identification
C. Disease
Management
D. Health
system
strengthening
E. Patient
segmentation
F. Evidence
based
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
C.4 Follow up &
closure
F.1
Personalized
follow up
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
C.1 Drug Rx &
dispensation
C.2 Specialist
consultation
C.3 Referral
services
C.4 Follow up &
closure
C.5 Periodic
diagnosis
D.1 Training of
health out reach
workers
D.2 Partner with
Public health
system
E.1 Systematic
risk
assessment
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
B.1
Community
screening
C.1 Drug
prescription &
dispensation
E.1 Systematic
risk
assessment
B.2 Door to
door screening
C.1 Drug
dispensation
C.3 Referral
services
C.4 Follow up
F.1
Personalized
follow up
Health
information
hot line
Tele-
medicine
4 Wheeler
2 Wheeler
Primary
Health center
Piramal Swasthya Platforms & NCD services
Not Applicable
7. 6
NCD projects at Piramal Swasthya: Reach, services &
Impact (2013 to October 2015 – project areas: Assam, WB, Odisha, Telangana)
Screened 5,25,775 beneficiaries for Hypertension and Diabetes
Diagnosed and confirmed 67,445 cases for Hypertension and Diabetes
Confirmed 56,485 comorbid cases through outreach screening and diagnosis
Representative case study – Project area Assam
• Patient ID: SP0223005380B000441; Date of registration : 11/27/2014 – Time - 02:30:32 PM
• Diagnosed for : Diabetes Mellitus
• Diagnosed through Lab test : RBS
• Lab test result : RBS = 263 mg/dl (at the time of registration)
• Intervention: Beneficiary was put on Metformin for 2 months with follow up
• Patient revisit date : 01/25/2015 – Time - 12:14:35 PM
• Lab test result on revisit: RBS = 140 mg/dl