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Among NCDs, hypertension is the major risk factor for highly prevalent cardiovascular diseases (CVDs) in India. The Annual Health Survey, 2014 reported prevalence of hypertension as 20.1% in rural Bihar for individuals above 18 years. Prevalence of prehypertension will have a cumulative effect on the existing disease burden in the near future thus making it necessary to try out various innovations that provide screening and timely management for hypertension in the state. Research has shown that pharmacists can enable prevention and early detection, and can help in optimizing and ensuring compliance with medicine therapy regimens among individuals with NCDs. Pharmacists usually act as the first point of contact for healthcare among the rural population. Therefore, leveraging pharmacists in the social franchise model by providing them with appropriate training, equipping them with technology, and by giving the right incentives, pharmacists can be enabled to provide focused interventions, specialized counselling, and care coordination. This could lead to improved patient engagement and help achieve better outcomes against NCDs.
In this context, MIHM is assessing a telemedicine-enabled, task-shifting based private sector primary healthcare model for the management of hypertension in Bihar. The primary objective is to assess if a greenfield prototype of pharmacy-led opportunistic screening for hypertension can increase patient enrolment in hypertension care, improve awareness of hypertension status, and/or improve the proportion of individuals with controlled blood pressure.
ISB MIHM implemented a hypertension care programme involving task-sharing with 20 private pharmacies between November 2020 and April 2021 in two blocks of Bihar. Pharmacists conducted free hypertension screening, and a trained physician offered free consultations at the pharmacy. We calculated the number of subjects screened, initiated on treatment (enrolled) and the change in blood pressure using the data collected through the program application and found that task-sharing with private pharmacies can lead to early detection and improved control of blood pressure in a resource-constrained setting. However, additional strategies to increase patient screening and retention rates are needed to ensure sustained health benefits.