Treatment is billable, but prevention is often forgotten

As healthcare practitioners, we realize our healthcare system puts a focus on treatment over prevention. Yes, limited resources play a significant role in this, but did it always have to be this way? The healthcare system has traditionally been more focused on treatment, which is often more costly and less effective regarding long-term health outcomes compared to preventive measures.1In his recent book, Outlive, Dr. Peter Attia talks about the evolving healthcare industry. As he puts it, Medicine 2.0 is our current state, where we wait for the “four horsemen of chronic disease” (heart disease, neurogenerative disease, metabolic syndrome and cancer) to strike. We need to shift to Medicine 3.0 which is proactive and aims to prevent these diseases. Let’s briefly discuss targets and how they determine treatment. Guidelines should be updated when evidence shows there is a high probability of future complications. However, why is an A1C of 5.9% treated differently than an A1C of 6.1%? One is on the edge of being pre-diabetic whereas the other slightly higher value sets in motion a different course of action. Although these values are not arbitrary, minor variations can spur different treatment decisions. By shifting our lens to treating people more holistically, we can prevent disease progression upstream.Prevention in healthcare includes interventions such as immunizations, health education, lifestyle modifications and screenings. Preventive measures are designed to ward off illnesses, reduce the incidence of disease and maintain overall health. In Canada, the Public Health Agency of Canada (PHAC) is responsible for supporting prevention strategies, including overseeing the National Immunization Strategy. But is this enough? Despite the known benefits of preventive services, their use and implementation remain relatively low because of financial and economic barriers. The four-year cycle of politicians also limits investment in the long-term health of Canadians. But this does not mean it is impossible. In its Bluezone 2.0 initiative, Singapore has implemented several initiatives that have extended its citizens’ lives. Through its national steps program— taxing sugar, imposing significant duties on driving and using the tax revenue generated towards improving public transport—they have taken a comprehensive approach to narrowing the gap between lifespan and health span.Intangible benefitsBeyond direct cost savings, there are broader economic and societal benefits of preventative care. Loss of productivity caused by chronic illnesses, for instance, costs the economy millions of dollars annually. We can mitigate these economic losses by reducing chronic disease prevalence through effective preventative measures. Additionally, preventative care contributes to corporate competitiveness, children’s education, mental health, and community well-being. These intangible benefits, although difficult to quantify, are vital for a healthy society.2Can we measure preventative initiatives?Yes, we can! Quality-adjusted life years (QALY) is a generic measure of disease burden that combines length and quality of life into a single number to assess the value of medical interventions. Its values range from 0 (dead) to 1 (perfect health).High-value QALY (Quality-Adjusted Life Year) examples are interventions that provide significant health benefits at a relatively low cost, improving the length and quality of life. Pharmacists play a key role in this area. We are heavily involved in disseminating services with the highest-value QALYs including:Immunizations: Vaccines are highly cost-effective at preventing serious illness and disability.Smoking cessation programs: Interventions to help people quit smoking, such as counselling and medication, can prevent lung cancer, heart disease, and other smoking-related illnesses.Utilizing pharmacogenomic data to prevent drug interactions, helps with choosing effective therapeutic options and decreases the time it takes to get patients to their therapeutic doses.Making recommendations to physicians to increase the use of cardiorenal protective agents like GLP1’s and SGLT2’s.Using CGM technology and analyzing AGP reports to achieve A1C and time-in-range TIR targets faster.These are all evidence-based ways pharmacists can focus their efforts and services to promote a prevention-based practice. Wellness on the horizonLooking forward, many companies are extrapolating this idea of preventative care by producing innovative products directly for consumers. Here is a sneak peek at some of the technologies now available (some are only in the U.S.).Home health hubs are innovative healthcare platforms designed to provide integrated and coordinated care within the home environment. Unique products such as AI bathroom mirrors from Baracoda and NuraLogix analyzes facial expressions for daily mental health checkups. Virtual care is the new norm, but what about bringing doctor's visits home? Withings recently added a handheld "multiscope" that combines a thermometer, thermometer, oximeter, and ECG. A new platform from Ultrahuman assesses air quality, temperature, humidity, and light exposure in your home. Smart rings have as many players as smartphones with Movano, Lotus, Amazfit, and YogiFi chasing Oura. Glucose monitoring is expanding beyond diabetes patients. Abbott is launching Lingo in the summer of 2024, while Dexcom is working on Stelo, its metabolic health-focused series. Levels Health uses existing CGM technology to provide insights for non-diabetics. Sidestepping CGM’s altogether is January AI which has a new app that predicts glucose levels from food photos.Pharmacists play a pivotal role in shifting the narrative when it comes to providing care for patients. One of our most important roles is to educate the public. We are trusted, accessible, knowledgeable and more than capable of leading this charge towards preventative care.References:[1]https://hbr.org/2021/12/5-critical-priorities-for-the-u-s-health-care-system[2]https://pubmed.ncbi.nlm.nih.gov/22052182/Manjit Hansra is the founder of Rx for Renewal (www.rx-renewal.ca). Through keynote speaking, 1:1 coaching, corporate wellness programs and curated retreats, he shares evidence-based and practical tools to help pharmacy organizations and pharmacists prevent and manage burnout. 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Treatment is billable, but prevention is often forgotten

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Manjit Hansra

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