The Role of Pharmacists in Combating Non-communicable Diseases (NCDs): A Response to the Outcomes of the 71st World Health Assembly of WHO held in May 2018

Background

According to WHO, noncommunicable diseases (NCDs), also referred to chronic diseases, are diseases of long duration and are the result of a combination of genetic, physiological, environmental and behavioral factors. The main types of NCDs are cancer, diabetes, cardiovascular diseases (heart attack stroke, and congestive heart failure), and chronic respiratory diseases (such as asthma and chronic obstructive pulmonary disease). These diseases disproportionately affect people in low and middle-income countries where more than three-quarters of global NCD deaths occur [1].

Key highlights on NCDs from the 71st World Health Assembly of WHO held in May 2018

• NCDs kill 41 million people each year, equivalent to 71% of all deaths globally.
• Each year, 15 million people die from an NCD between the ages of 30 and 69 years; over 85% of these premature deaths occur in low- and middle-income countries.
• Cardiovascular diseases account for most NCD deaths, equivalent to 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9 million), and diabetes (1.6 million).
• These 4 groups of diseases account for over 80% of all premature NCD deaths.
• Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of NCDs and dying from NCDs.
• Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs [1].

WHO also projected that efforts to reach target 3.4 of the Sustainable Development Goals SDG (by 2030 reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being) require that the existing political commitments made at the United Nations General Assembly in 2011 and 2014 be implemented holistically [2].

The resolution of the WHA 71.2 supports efforts towards achieving SDG 3.4 and to step up efforts on prevention and control. The resolution also urges member states to engage in the preparation of high-level meetings at all levels and encourages the participation of Heads of State and Government and a call for action through a concise, action-oriented outcome document.

Furthermore, developing countries stressed many issues that need attention in combatting NCDs. These include access to quality and affordable medicines, implementation of measures such as taxes to discourage consumption of harmful products like tobacco, sugar trans-fats and products that are directly marketed to children which also increase the risks associated with NCDs. It was emphasized that in order to make progress it will be necessary to have international cooperation and support for developing countries. Some developed countries emphasized that interventions need to be scientific and evidence based, and the discussions should include all stakeholders and private partnerships [3].

The effective use of pharmacists’ knowledge and skills have been shown to improve the delivery of healthcare services. In recent time, the role of pharmacists has expanded beyond traditional compounding, dispensing and packaging of medicines. In many developed countries, including some developing countries, pharmacists are now also actively involved in many facets of healthcare delivery ensuring safe and quality use of medicines, promoting public health, providing primary healthcare services and providing palliative care [4–5].

There is evidence that pharmacists can contribute substantially to the prevention, treatment and management of NCDs around the globe. Pharmacists can contribute by screening and monitoring NCDs, patient counselling on medication adherence, providing medication therapy management services, promoting public health, and improved access to quality and affordable medicines [6].

Some of the potential areas where pharmacists can contribute substantially to combat NCDs are discussed below:

a) Screening and monitoring NCDs: Pharmacists are already making significant contribution to the healthcare system by screening and monitoring the progression of NCDs in patients. Studies in many countries show that community pharmacists are adequately capable and ideally placed to screen for different conditions including diabetes, cardiovascular diseases, asthma, COPD, breast cancer, and bowel cancer among many others. There is sufficient evidence that pharmacist-led monitoring programs contribute to the prevention and management of NCDs. Pharmacists have been actively involved in monitoring blood pressure, blood lipid profile, blood glucose level, lung function and anticoagulant therapy [6].

b) Patients counseling on medication adherence: One of the best ways to improve medication adherence for patients with NCDs is patient medication counseling/education, which is an important means for achieving pharmaceutical care. It is defined as providing medication related information orally, in written form, or using other reasonable demonstration tools forpatients or caregivers, on topics like direction of use, advice on side effects, precautions, and storage conditions, diet and life style modifications. The goal of counseling, particularly for patients with NCDs, is to provide information directed at encouraging safe and appropriate use of medications, thereby improving therapeutic outcomes [7]

c) Medication therapy management (MTM): this is provided by pharmacists with the aim of optimizing drug therapy and improving therapeutic outcomes for patients, often in collaboration with other healthcare professionals. MTM includes five core components: a medication therapy review (MTR), personal medication record (PMR), medication-related action plan (MAP), intervention and/or referral, and documentation and follow-up. MTR is a systematic process of collecting patient medication-related information which occurs during the pharmacist-patient encounter. It is followed by the preparation of a personal medication record for each patient. From the PMR, pharmacists identify medication related problems and develop action plans. Pharmacists may interact with patients independently (e.g. adherence counselling and addition of non-prescription medicines) or may refer them to suitable healthcare professionals (if an intervention is out of the pharmacist’s scope of expertise). MTM in the case of NCDs can provide patient-specific tailored service which may improve the response of patients towards their treatment plan. MTM is practiced in many countries and requires highly trained and skilled pharmacists. The recent shift in pharmacists’ interests towards community pharmacy services can help to promote pharmacist-led MTM services in developing countries [6].

d) Public health and health promotion: The pharmacists being widely accessible, and trustworthy professionals, can serve as excellent promoters of public health. Pharmacists are regarded as good health educators by the public. There are many models of health promotion by pharmacists. Pharmacists can organize mass education on lifestyle modification, screening of breast cancer, blood pressure, tobacco cessation and diabetic education programmes. These are few examples of health promotion activities that pharmacists can be actively involved in and will make serious impact in the prevention and treatment of NCDs [6].

e) Improved access to quality and affordable medicines: pharmacists can play a pivotal role in providing quality medicines for patients with NCDs from the industrial pharmacy point of view, through continue research and development into the special needs of patients with NCDs. These may include technologies for customizing their medication in order to suit the special needs of an individual patient. On the other hand, pharmacists also can play a key role as middlemen between pharmaceutical industries and patients with NCDs, ensuring that their medicines are not out of stock and are being kept under suitable storage conditions (such as insulin).

Conclusion

The role of pharmacists in combatting NCDs can never be overemphasized. Pharmacists can actively play dual roles in this direction, through both prevention and treatment of NCDs. However, there are challenges in achieving the full potential of pharmacists’ knowledge and skills in the control of NCDs especially in the low and middle-income countries where the burden of NCDs is higher. These challenges include low pharmacist manpower and under-utilization of pharmacists’ potentials in such countries.

References

1. http://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases accessed 14/08/2018

2. Preparation for the third High-level Meeting of the General Assembly on the Prevention and Control of NCDs, to be held in 2018: http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_15-en.pdf accessed 15/08/2018

3. Major Outcomes of the 71st Session of the World Health Assembly of WHO: https://www.southcentre.int/wp-content/uploads/2018/07/PB49_Major-Outcomes-of-the-71st-Session-of-the-World-Health-Assembly-of-WHO_EN.pdf accessed 15/08/2018

4. Santschi, V., et al., Impact of pharmacist care in the management of cardiovascular disease

risk factors: a systematic review and meta-analysis of randomized trials. Arch Internal Med

2011. 171:1441–1453

5. Chisholm-Burns, M.A., et al., US pharmacists’ effect as team members on patient care:

systematic review and meta-analyses. Med Care 2010. 48:923–933.

6. Khanal S., et al., Pharmacy workforce to prevent and manage non-communicable diseases in

developing nations: The case of Nepal: Research in social and administrative pharmacy. RSAP. 2016;12(4):655–9.

7. Kumanan R., et al., Can a pharmacist improve life of diabetes patient? An overview. Research Journal of Pharmaceutical Biological and Chemical Sciences. 2010;1(3):5–11.

-Article by Khalid Garba Mohammed