Pioneering Adoption Of Behavioral Strategies In Primary Care Medicine

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Physician skills such as communication and inculcation of positive behavior changes and self-care are not innate abilities but teachable and learnable skills. The principles of collaborative care are appearing as an emerging trend of modern day medicine. Pioneering work in the integration of behavioral medicine with care for other chronic conditions to benefit patients has been boosted by the efforts of Dr. Kiran Kumar Panuganti, Physician Champion of the Infection Prevention Cabinet and Vice-Chairman of Medicine at Presbyterian Hospital in Denton, Texas. Sreerupa Patronobish recently interviewed Dr. Panuganti and how his efforts can aid patients in the Indian scenario.

SP: Welcome Dr. Panuganti
KKP: Thank you for having me.

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SP: What is the rationale for your stress on behaviour changes as an avenue to reshaping primary care practice?

KKP: The current buzz word is “prescription for health”. This is mainly focussed on reducing high risk behaviors including smoking, unhealthy diet, risky use of alcohol and physical inactivity. Primary care is the largest platform of health care delivery in the United States and is the corner stone to equitable, high quality sustainable health care. The redesign of health care, especially primary care, offers timely opportunities to address important behavioral risk factors from a Patient-centred medical home (PCMH) perspective.

Behavioral factors explain greater than 50% individuals who get sick and die prematurely in the United States, so managing behavioral issues is a critical component of promotion of health.

SP: Every doctor would be vested in providing whole-person care. So what are the unique elements that you bring onto the system?

KKP: True that many of my colleagues are highly focused on gaining health for their patients but I truly believe in transformative changes and developing a microcosm of health care, based on my ongoing personal relationship with my patients. I create a proactive and reactive environment in which health promotion becomes a priority-set goals. Herein lies the underlying basis for my reinforcement strategies through the websites like thinkbeforefollowing.com. Or say, consider the repetitive messages incorporated through judiciousabx.com. Handwashing, though seemingly elementary, is practised by only 40% individuals in the ICU. There have been systematic studies from the Mayo Clinic which has demonstrated this. On the other hand, roper handwashing can prevent serious and life-threatening infections that occur in the ICU, for example, like Acinetobacter pneumonia, which arises from common skin commensals. It is so much imperative that robust campaigns be made to prevent these hospital-acquired infections, which still results in ramping up of billions of healthcare dollars spending.

SP: How would you at all know that your target population would look at the website that you have designed?

KKP: We shall not have this data upfront. However, the significance of dissemination of this information is prime. Globally the use of communication technology such at internet and mobile phone continues to rise exponentially. Health promotions will expand out from the “old” media like TV, radio and billboards into the realm of the “new”, i.e., mobile telephones and social networking sites. A rapidly emerging body of literature supports the use of technology in health promotions interventions. Largely, it results from portability and privacy. Thus, it also circumvents the issues of stigma associated with discussing these different conditions within the confines of the clinic.

I have raised awareness about stigma related to various infectious and non-communicable diseases through the portal www.stigmainhealth.com. Health promotions is particularly pertinent during adolescence. This is because this is important for adolescents to form healthy habits that they can maintain throughout adulthood, to be aware of symptoms of health issues and minimize risk for preventable health issues. The campaign through “thinkbeforefollowing” is really serious in mitigating the adoption of smoking habits in young adults, especially females. As you know, the incidence of lung cancer in women is rising.

SP: What is your test that your goals of behavioral changes are being reached?

KKP: We surely need to perform controlled studies. But I consider a great call onto myself to robustly spread the message, far and wide, through all possible means of media. Internet use is increasing rapidly. Since 2000, there has been a 676.3 percent increase in the number of users, with 2.8 billion web users worldwide at the end of 2013. One US study found that, in 2009, young people (8-18 years) spent an average of 7.5 hours online each day. While such evidence alone demonstrates the internet’s popularity among youth, it is likely that its use has increased substantially over the past few years as social networking sites have become more popular, and schools increasingly require students to bring internet-enabled devices to class. Web-based health promotion interventions also offer autonomy and anonymity for help around topics that may be sensitive and/or stigmatised. The random alleys of information dissemination do make a significant impact on health behavior changes.

SP: How does your smartphone applications find relevance in India?

KKP: Globally, 91 percent of people have access to a mobile phone. In India, mobile phones have become an important form of communication as they have a much broader reach than other communication technologies (e.g. landlines, television, internet). Promisingly, mobile phone interventions enhance the potential of reaching hard to reach groups (e.g. youth, those who change their address frequently, or those not accessing health services regularly) and underserved populations who may face barriers to accessing other technology modes. There is emerging evidence to demonstrate the effectiveness of mobile-phone based health promotion interventions in addressing a wide range of health issues.

Although delivery modes vary, there are many key advantageous features of mobile phone-based health promotion interventions. First, they provide a convenient approach for users as they are a direct link of contact at any time or place. Second, although the small screens of mobiles may limit program complexity, it means that it is very easy to update content, and thus places fewer demand on staff running interventions. Third, mobile-phone based interventions are possibly one of the lowest cost approaches in health promotion. A final key benefit of mobile-phone interventions is that the medium allows for easier monitoring of participant engagement and exposure.

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