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WHO advice on screen time for children under five?


1.      That for children under one-year… sedentary screen time (such as watching TV or videos, playing
computer games) is not recommended and that when sedentary, engaging in reading and storytelling
with a caregiver is encouraged.
2.       That children under two years of age should have no screen time whatsoever
3.       For those aged two years, sedentary screen time may be no more than one hour; less is better.
4.       That three and four-year-olds should not play with iPads or watch television for more than an hour
a day ( less is better).
5.       WHO recommends at least 180 minutes in a variety of types of physical activities for three-to-four-
year olds.
6.       Improving physical activity, reducing sedentary time and ensuring quality sleep in young children
will improve their physical, mental health and well being.

The nuances of contemporary society in the above context:

During our childhood, before 1960, there were no TV, video games, mobiles etc. Only radios were
available and that also one radio per 15 to 20 families. Apart from filmy songs at a predefined time, all
programmes were for knowledge and science. Our only pass time was playing all sorts of games starting
from early morning till late evening with  a break for school and when mothers caught hold for feeding.
In the school also there was one hour compulsory physical training. For PT there used to be a PT
Teacher, full attendance was necessary and carried marks in the examinations. Because of that we enjoy
better health at present than our children.
What WHO has recommended is very correct and must be implemented.
The problem is how ? Now majority of middle class  families are living in 2 bed room flats where TV is on
most of the time, If it is stopped the whole family will have to be denied TV. Schools are running in few
rooms with out play ground.
So, it is a big problem and the solution is very much elusive.
Children under FIVE years of age need to spend more time with their parents, trying to imbibe the soft
and hard skills of life over this period and beyond. They learn on the successes and failures of daily
activities of life and experiences too, which is called “imprinting in the brain”.
Many parents indulge in handing over mobile phones/tablets to very small kids to keep them distracted
and occupied in order to complete the task of mechanically feeding them …or getting them ready for
school, as a quick fix measure. This act should be condemned !
That the child in question cries inconsolably without such gadgets, is an unacceptable excuse

Digital Detox

This phenomenon / concept is in crying need of the hour.
The society at large has become a ‘ slave’ to the digital revolution and its nuances. We hardly see
someone who displays a considerable freedom from such digital devices in the present times.
Admittedly…the arrival of digital personal devices have revolutionized our lives in a big way….but the toll
it has taken on our lives is often immeasurable and disastrous. The moral decadence of society cannot be
ignored !

Signs of digital addiction and abuse…………………………………….

1. Engaged with a digital device of any kind, for most waking hours of a day
2. Strong distraction at home and at work place with digital gadgets..thereby causing interactive
issues with peers and those around. This goes to such an extent that house members sitting in
adjacent rooms are often found communicating through digital devices amongst themselves !!!
3. People are very often unable to feel comfortable without looking at their personal gadgets….
many a times….every five-ten minutes. Employees working at office are terribly overpowered to
check their personal emails and social media accounts, every now and then…to that extent that
employees cannot restrain themselves from gazing at their phones during Interview sessions and
important board meetings at office…IN PRESENCE OF THE BOSS !!!
4. People on their mobile devices who scan the social media very frequently feel a terrible urge to
respond to friend requests/postings/comments, to feel that they are of importance to the one at
the other end and that they do not lag behind in any way !! They feel tremendously relieved to live
in a competitive make believe world which is exclusively illusive.,..often bringing in frustrations in
their own lives !
5. School children many a time pester their parents to give them mobile phones citing silly reasons,
to which the parents relent without any after thought and then suffer the consequences in a bitter
manner..at a later date. Prior to the era of digital technology arriving in a big way….there were
generations of students and parents who never faced any problems in their day to day lives !
6. The situation has come to such a passé…that very often personnel in demanding
professions….for ex. Hospital / Aviation industry / Railway personnel… are busy with their
personal devices often at the cost of a set back/potential loss of money/time/even a life-in a few
cases.. to the served target subjects …!! There are many examples which can be cited on such
7. Crimes of any conceivable nature have arrived in the scene…which are principally committed by
the help of such digital gadgets and persons of all ages have become very vulnerable now to fall
victims of such unhealthy trends,including emotional / otherwise blackmailing, to make any digital
records viral in the social media. The society is grappling in a major way within the framework of
cyber laws and cyber judiciary regulations to grapple with such issues seeking and aiming to
bringing he offenders to book, in the name of justice.
8. Many people feel a vague subjective discomfort without access to their personal digital devices
around them and display overt features of bodily symptoms such as vague aches and
pains..headaches…lack of concentration….suppressed anger…improper sleep….lack of appetite
etc etc. They may get labelled as subjects with psycho-somatic illnesses to which the remedy
though simple , often stays elusive.
9. Clear health issues may overcome the well being of digitally addicted folks….in the form of
“Computer Vision Syndrom”e..affecting the hands/neck/eyes/body muscles in a significant way
following excessive usage of computer devices which require long staring in defective postures at

Suggested ways for a detox from the digital world………………………………..

1. Begin a practice of digital abstinence….initially for short spells..maybe an hour or so…and slowly
increasing it on a daily basis. The abstinence should be applicable to holidays also !

The results of such self-restraint get obvious over a period of time.
2. Parents to decide very critically in allowing their children the personal usage of mobile
phones/tablets etc…based on a no. of factors such as age/necessity/any tendency to
communicate with friends in the sly/duration of holding these devices on themselves/any
tendency to lend these devices to friends/associates for abusive use etc.
3. Parents of children of all ages should be checking on the Internet usage nature very intensely in
order to prevent them having access to obectionable/adult sites and make an effort to ban
such web access in their home/individual devices. Lack of vigilance on the part of
parents/guardians often lands up the concerned under age folks and family in an unanticipated
trouble to their already burdened lives ! This is very important with growing children at home
and should not be neglected.
4. Encourage people as much as possible in offices…..public transport modes…public places..to
engage in more of personalized conversation and exchange of pleasantries, rather than spend
most of the time hooked on the LCD panels of their devices in hand…!!!
Get back to the dying habit of wishing and greeting people on their face with a smile.
( The smiles should come back on their faces, instead of through emoticons in their digital
devices ).
5. Taking a short break from the mundane chores of daily lives……….when the digital devices are to
be totally shunned till normal lives are resumed again ! This shall be a welcome change which
the body may be craving for a long time.
6. Children and students should be encouraged to spend more quality time outside in the
playground at simple games which involve a good amount of physical exercising and running
around for improving their concentration at work and preventing that much hated complication
of ‘Childhood Obesity’…which gets over time transitioned to ‘Adult Obesity’ !!
Addiction to digital devices contribute to Obesity in a major way across all ages.

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iKure introduces non-Invasive Hb tests for last mile community


On a Tuesday afternoon, Shivani while returning from her field, noticed a banner in a primary school about a health awareness campaign for mothers and children. She found few of her friends waiting there too. Shivani enquired about it and came to know that the campaign was providing diagnostic tests for Hemoglobin and with a doctor consultation.

Shivani then asked them won’t it be painful? “I never had any Hb test before, but I have heard, they prick it hard and collects blood in good amount”. As she was thinking of returning back, she noticed, this Hb test was different. It neither involved a needle, nor did it collect any blood sample. Shivani decided to give it a try. And later, she revealed that she made the right choice by staying back!

That day, like Shivani, there were Urmila, Kusum and Malati who attended the health awareness campaign, availed Hb test, doctor’s consultation and discounted medicines before returning back to their home. On way back, for the first time, they discussed about their haemoglobin count and how they need to take care of themselves better.

In the rural region of North Karnataka, and West Bengal, what has changed for these women is access to life-saving diagnostic care within their community, and even their door-steps- all facilitated by iKure.

Globally, rural communities face limited access to point-of-care diagnostic tools. Incidence of anemia in rural pockets are staggeringly high, since a simple Hb test require long distance travel time to diagnostic centres or waiting in long queues in health centres. In such situation, rural women delay getting an anemia test done in the first place, with their family members pay little or no heed towards the importance of such tests.

In response to the need, iKure introduced non-invasive diagnostic tests in rural hinterland that can be conveniently used by its health workers in campaigns and during their home visits.

The diagnostic system takes the images of the lower eyelid, analyses the picture to quantify the conjunctival pallor and studies the paleness of the mucous membranes caused due to reduced amount of oxyhaemoglobin in the blood. Further, the point-of- care can be linked to patient’s smartphone via Bluetooth on which all data can be directly sent to patient as required.

The use of point-of-care technologies for quick tests is widespread in public health system, but the benefits of using them are only limited to health workers. As such device comes with minimal maintenance costs, highly portable and handy, it can be used for self-testing, testing in communities by health workers, testing in clinics and hospitals that can significantly reduce the rapid turn-around time and enable access to treatment regimens almost instantly.

Using conventional technologies in laboratories make turn-around time long and in the process patients do not return for further treatments. But, use of such point of care diagnostics in hard-to-reach communities play an important role in convincing the women community from dropping out of the existing treatment regimens and rapid testing holds prospects in improving the knowledge of the patients about their own medical situation bringing more awareness towards their dietary pattern, nutritional supplements and even in health seeking behaviour.

As iKure is aggressively involved in disseminating new technologies in its existing healthcare model that links its end-users to the higher level of care, it also works with various stakeholders like NGOs, Self-help groups to bring sustainable changes in women’s health outcomesso that do not remain entangled with their family life and complex choices.

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How much does a Pair of Eye Glasses Costs for People at the Last Mile?


Vision impairment due to lack of access to eyeglasses has been identified as one of the largest unaddressed disabilities in the world. There are many remote villages, where getting a pair of eyeglasses is a distant dream for many. With a pair of glasses costing pittance, 550 million people in India are still in dark. Whereas, there are other parts of the world, where the first reading eye glasses can be picked up easily from a grocery store or a pharmacy.

Of all the eye problems, the commonest eye problem results mainly due to refractive error causing hyperopia, presbyopia, or myopia, and which can be easily corrected using eyeglasses. Refractive error is a condition where a person is unable to focus clearly on an object. Above the mentioned problem, Presbyopia is the most easy to correct just by trying out different corrective glasses. But, quite apart, such diseases remain largely untreated. Vision impairment is more than just a health disorder. It has economic, social and public safety implications and with variety of approaches tried and tested, to date none have succeeded on a larger scale.

iKure’s eye care intervention shows 78 per cent need access to eyeglasses particularly among them are construction workers, bus drivers, and school going children. With the staggeringly high impaired vision, the quality of life remain hampered, translating into reduced productivity, economic losses and huge absenteeism in school.

With the mission to bring eye glasses to all who need them, iKure has potentially paved the way for a new beginning in dissolute communities. With access to simple pair of spectacles, the venture has drastically improved earning power, educational prospects, and enabling every day task easier. Post intervention, our beneficiaries have reported to feel motivated with positive social and economic outcomes, better learning behavior and even fewer road accidents. So far, iKure through its eye care initiative has helped more than 0.5 million people get access to corrective eyeglasses.

Another approach initiated by iKure includes access to power testing using state-of-art technology. The use of advanced technology has facilitated getting corrective eye glasses with reduced chances of manual error, bringing ease of using among the end-users.

While the problem too large to scale, but simple enough to solve, we look forward to working with partners and Govt. initiatives to bring the first pair of eyeglasses needing them.

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Featured, News, Tech

Why celebrate World Senior Citizen Day?


iKure’s purpose in celebrating world senior citizen day is to raise awareness and support the health conditions of older people.

21st August is regarded as World Senior Citizen Day. Anyone beyond 60 years of age is a Senior Citizen by convention.We cannot help but lamenting that we cannot boast of having done anything remarkable on the welfare of Senior Citizens of this country by the method of policy…and this matter does not fare high in the list of authoritative priorities.

Nevertheless, bodies and associations have come forwards since not too long, to think on this sensitive issue and create a better living for a senior citizen across this country.

Old age homes have started dotting everywhere but the terms and conditions for housing them must be subsidized to include more and more of such population….without too much of a burden for the self-financing groups. Old people remain isolated from the family buzz and children moving to greener pastures leave such hapless people vulnerable to the nuances of social insecurities and bodily morbidities. They become alienated from the families they once took pride in building up and become redundant in the household of younger folks. Their opinions do not matter anymore in the day to day lives of the gen X and the seamless peace of life gets replaced by daily miseries of psyche and dignity. They are made to be figured out as burdens to the society.

Senior Citizens are prone to suffer from several clusters of diseases as below:

Cardiovascular ailments…acquired over their lifetime which needs to be addressed seriously. Coronary Arterial disease/Valvular disorders/Heart Failure/Heart Attacks (AMI) dominate the,list of morbidities in this group.

1. Lifestyle diseases such as Hypertension/Diabetes/Dyslipidaemias/Obesity form the prominent members of this groupacquired as a result of erratic/unrestricted lifestyle and often with genetic predisposition. They need lifelong care from Physicians attending them periodically, for as long as they would survive.

2. Gastrointestinal conditions like..Colonic disorders/Chronic constipation/GERD/Anorectal diseases/ Genitourinary diseases…. form another group which need either one time attention, or, follow up with the respective Speciality Doctors.

3. Neurological conditions like Stroke causing bedridden morbidity with/without paralysis needing prolonged close care by family members/attendants…or….physiotherapy for extended sessions form a bulk of suffering in this age group..

4. Miscellaneous category…comprised by Psychiatric illnesses/ Abandoned cases /Victims of physical abuse/Discharged from Hospitals or infirmaries with no family contact/ Addicts to Drugs and Alcohol / Homeless ones… etc.

All the above ailments require financial help and social inputs to manage the vulnerable segment of population and the dreaded solitude that it entails…which in itself brings down the life span of such seniors….the octogenarians and nonagenerians in society.

There are many countries where such people form a major part of the living society…such as Japan…who can boast of well laid down policies and generous grants from the government, to take care of the issues related to old age survivors and their health matters.

In india we are still far from this achievement in a mentionable way but efforts have just begun! The discipline which deals with medical issues of this age is called “Geriatrics” and Doctors are getting specialized in this field to work with only senior citizens.

Our mindset needs to change to support and care for the people of such advanced age in their twilight years and not regard them as just ‘gone over the hill’. ..!

Children need to be more sensitive and empathic to the needs of their parents who brought them up and not forget that they are also going to reach this age one day in future.

We need to approach this social malady in a holistic and pragmatic way seeking cooperation from NGO-s and similar social workers and a teamwork of trained personnel to come forwards in solving this growing issue of ‘unattended in old age’ concept.

How iKure is working towards the welfare goals of senior citizens?

“iKure” is an exemplary organization striving towards the very challenging goal of making the lives of our citizens better through many of its innovative ways and means, often defeating the challenges of human resource mobilization and deployment………..meaningful utilization of available resources…and constantly looking for areas of intervention in healthcare…in domestic & international geography, to mention a few!

In its ambit of operations…iKure has allotted priority to some areas of suffering of fellow human beings,such as Lifestyle diseases ( NCD-s) which is a modern scourge to humanity.

Across the intervention areas of this organization, a sizeable portion of the target community served hails from this group….the Senior Citizens….for whom we pay a little added focus, because of the enumerous socio-economical nuances, that such people have to face in their day to day lives.

iKure organizes medical camps from time to time…..serving the regional population…many of whom are of advanced age..in the areas of NCD-s….with regards to an holistic approach…which includes not only management of such ailments but the relevant health education required to understand such diseases…up..close..and personal ..by gaining knowledge on the occurrence causes…preventive modalities…and complications which may come up…for those who unfortunately have fallen victim to such diseases.

iKure attaches a lot of importance on Eyecarewhich is predominantly skewed towards the elderly folks, in addressing the conditions arising in old age such as Cataract/Glaucoma/ARMD/Retinal deterioration etc. The organization applies modern technology to detect such conditions in a proactive manner, screens the population of such sinister eye diseases and guides them through the scientific protocol of management /referral of such cases, being affected by specific eye diseases. Had this not been in place, a lot of hapless and underprivileged people would have lost their eyesight by now!

The mechanism is on.. to increase the door-to-door surveillance of the segment of the senior population affected by Cardiovascular Disease by means of remote monitoring and coordination through wearable devices …..under experimentation for implementation policy. This will go a long way to detect major and minor cardiac ailments for a timely referral to the domain of specialists to address the particular issues.

Last but not the least…iKure is in the planning stage to enter into a rather new concept of “ Continuum of Care“…wherein….it can collaborate with secondary/tertiary Medical Centres,to take care of interim/transitory patient care for the welfare of patients in the home settings of such clientele, many of whom are senior citizens.

With iKure’s integrated efforts, we can only hope that the plight of senior citizens gets better with time in this country and around the world…in order that this day is celebrated with increasing fervor in society…in times to come.

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Featured, Tech

iKure Celebrates National Nutrition Week


The National Nutritional Week ( the first week of September) concept was created by the Govt. Of India in 1982 to emphasize,educate and create awareness among people on the importance of eating/drinking the right kind of nutrients and the impact it has on the health of a person.

The word ‘Nutrition’ means the understanding of consumption of all edibles available to one, leading to the promotion of health and the word ‘Dietetics’ implies the management of facts and science behind the right kind of food elements towards good health and in conditions of disease, along with other preventative, prophylactic and therapeutic measures.

Nutrition is the fundamental birthright of all citizens of this country and one of the strong pivotal criteria of building a sound human base for the upkeep of this nation. The only way to create this in a continuous manner against all nuances is to provide the basic nutrition to all people of this country in the journey from ‘developing’ to ‘developed’ nation …beginning with breastfeeding just after being born to food guidance in the later years in life through all ages ! Lamenting though..we have not reached anywhere near to the standards of many a nation in this world…on this topic..which is not even given its due priority.

We can only wish a separate ministry by the name of “ Ministry of Nutrition and healthy consumerism “ be formed in India, to take care of the myriad aspects of nutrition plaguing this nation and the solutions needed to address the same.

‘Midday School Meals’ need to be taken much more seriously across the length and breadth of this country to plant the sapling of a sound nutrition to children who are the future citizens of India. There is no uniform policy in place for the proper utilization of funds allocated on this and just any combination of low grade food elements are used to serve such meals to children. ..often to the point of denial. This needs a serious redressal and soon. ‘Maternal and Child Nutrition’ needs to be looked into from a rather preventive angle.

‘Food adulteration’ is another area of mammoth deception to mankind for easy profits and takes a serious toll on human health in the long run. There is simply no effective law on this and the punishments are not grave and the involved people get away easily without any significant punitive measures. This applies to both raw food elements in the open market, as well as, semi-prepared and prepared food which is plain speaking unfit for human consumption. Recent instances of passing off animal carcasses as consumable meat to humans, form a glaring example to the height of daringness and apathy on vigil in this matter !

We need more Nutritionists & dietician to cover the large population of this country to work towards the sound health of people through Governmental and Non-governmental organisations and they should be empowered with authority to book the offenders and refer them for due legal recourse. This week is dedicated to initiate and start such projects across the states of this country ,with a varying theme each year, with regards to poor maternal nutrition/ill health of children/ignored health of poverty stricken population and more. There must also be stress on the educative aspects of this huge problem by different means of reaching the vulnerable segment of the population and guided by the general literacy of those affected. Group meetings with real time food sample demonstration sessions and a guide to elementary home cooking can go a long way to initiate a campaign towards sound nutrition of humans. Food analysis….random check on food vendors….and standardization of policies need to be implemented with immediate effect….to prevent the growing menace of food adulteration which has already cost a good no. of human and animal lives in this country of ours ! A good amount of research in nutrition as applicable to the socioeconomic fabric of this nation and monitoring the impact at the ground level…is also a perquisite.

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World Alzheimer’s Day


This Day is observed on the 21st September every year, as a day in the World Alzheimer Month…by organisations and foundations worldwide with this name.

Alzheimer’s disease is a slowly progressing cascade of cognitive decline affecting subjects in the senile age group and is regarded as multifactorial in its origin and with no significant treatment as yet, assuring a reversal or stoppage in the progress of this slow brain cell death…ending up with bodily cessation of functions in course of time.

The hallmark of this disease is dementia and this particular condition is the commonest cause of dementia affecting human kind.

It has an obscure aetiology this far ..speculated to being caused by the abnormal deposition of proteins amidst the brain cells….like Amyloid ..causing plaques and and Tau…which remain entangled with the neurons in the brain.

While the unmodifiable factor(s) could be…age/familial/genetic…modifiable ones could be lifestyle/environmental/smoking/depression-due to any cause/sedentary life in solitude /exposure to cumulative effects of noise /untreated hearing loss etc. Also morbid grief after losing a loved one , financial worries,health anxiety of chronic debilitating illnesses could be a common precipitant of this condition. It is seen to have a gender bias..as to slightly more common in women above 65 years than men of similar age.

Some common pointers towards this affection is the initial presentation of very mild memory loss/cognitive decline…appearing to be normal of this age, but gradually advancing to affect the normal ability of a person, to execute the very basic tasks of day to day lives and failing to recall the names of familiar persons and simple objects of life, accompanied with inappropriate social behavior and lack of mental restraints. With this begins a phase of dependency on others around, to lead a normal daily life and ultimately ending up with immobility and gross paucity of activities towards the terminal phase of this phenomena…of senile dementia.

Since this disease does not kill immediately…a chosen caregiver has an immense role to play in caring for such affected individuals in their twilight years.Empathy and not sympathy is the sheet anchor of an approach to any person affected with Alzheimer’s. In fact..it is always better if a normal personwho is supposed to play the role of a caregiver, to undergo a brief orientation session, as to how to deal with a person affected with Alzheimer’s Disease.

Some important aspects of communicating with persons suffering from this condition may be as below …

  • To speak in simple sentences with them,in a slow pace, stressing more on long term past memories and avoid asking questions which emphasize on short term memory.
  • On seeking for preferences….as to wishing to have egg/fish for lunch..it is better to show them the objects ,for a better clarity in the question and response.
  • The speaker must remain aware of his/her own’s body language or mannerism while talking to the affected one…focusing on direct eye contact and in the absence of any sensory distraction.
  • Demonstrate ample amount of patience while communicating with a dementic person…till the patient is able to comprehend the topic on which spoken to.
  • Never ever comment on the mental /intelligent set back on the faculties of an affected person in front of the communicator.
  • Be aware of the limitations of the affected person….on memory loss/difficulty in handling complex tasks/problems in planning and organizing their personal lives/difficulty in coordination and locomotion etc. etc.Preventive aspects on this condition are many ….which includes leading a simple lifestyle….avoid being affected by extremes of emotions…regular touch with friends and relatives….cutting down on caffeine intake to increase the sleeping hours,following a simple rule to keep the cognition active…by doing simple calculations mentally-trying to recall all those whom the person had met earlier in life-trying to place the names of persons by visuals (pictures/photos)-and spiritual recourse at convenient timings in day to day lives.

Researches are on for a definitive management strategy of this disease but the results are yet to come forth in a big way.

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“The six data collaborations chosen for our new peer learning network” – blog published by ODI

“The six data collaborations chosen for our new peer learning network” – blog published by ODI

Click on the link to read more: 


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Featured, Lifestyle

Continuity of Care in Primary Healthcare Delivery


What is Continuity of Care?

“Continuity of Care” is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality and cost-effective medical care.

Continuity of care is the primary objective of family medicine and is consistent with quality patient care provided through a patient-centered medical service. The continuity of care approach helps family physicians gain their patients’ confidence. It also facilitates the family physician’s role as a cost-effective coordinator of the patient’s health services by making early recognition of problems possible. This is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-person perspective efficiently without extensive investigation.

[The above is a lightly edited version of the definition of Continuity of Care from the American Academy of Family Physicians (“AAFP”) website.]

Continuity of care has several dimensions:

  • Relationship continuity: continuous caring relationship with a clinician
  • Management continuity: continuity and consistency of clinical management, including care planning, and any necessary co-ordination of care required by the patient
  • Information continuity: providing and sharing information regarding the patient across all care providers

Management continuity is relevant whenever a patient is receiving care from more than one clinician or healthcare provider. It concerns the processes involved in co-ordinating, integrating and personalising care to deliver a high-quality service. The General Physician’s (GPs) clinical responsibility as coordinator of care for patients includes helping patients to understand and plan their treatment, navigate unfamiliar services successfully and remain engaged with their care. Good relationship continuity can contribute substantially to achieving this. Having one principal care provider with a holistic view of the patient is central to patients’ experiences of good management continuity and provides a sense of security and confidence about the future.


Benefits of Continuity of Care

Continuity of care approach has significant benefits and will result in better care at a lower cost over a period of time. Some of the specific benefits include:

  • Increased trust in the doctor-patient relationship
  • Reduces fragmentation of care and improves patient safety (by reduction of medical errors), quality of care and outcomes in a cost-effective way
  • Enables early recognition of healthcare problems without extensive investigations and unnecessary medication
  • Reduces “collusion of anonymity” when “patient is passed from one specialist to another with nobody taking complete responsibility for the patient
  • Better accuracy of the patient’s medical records
  • Reduction in unplanned hospital admissions
  • Reduction in the use of emergency department
  • Better adherence to medical advice, especially regarding long-term prevention and wellness
  • Empowers patients to take greater ownership for managing their health
  • Reduction in secondary care (medical care provided by a specialist or a facility upon referral by a primary care physician)
  • Improvement in treatment of chronic condition and quality of life of patients
  • Ensures information continuity; patients dislike having to repeat their story to different clinicians
  • Improvement in patient satisfaction

Use of Technology in Continuity of Care
Technology is a major enabler towards ensuring continuity of care. Some of the key technology elements that are widely used for this purpose are:

  • Electronic Health/Medical Record (EHR/EMR): EHR/EMR is vital for maintaining information continuity across various care providers.
  • Continuity of Care Document (CCD): CCD fosters interoperability of clinical data by allowing physicians to send electronic medical information to other providers without loss of meaning, thereby ensuring better patient care.
  • Tele-Medicine: Virtual patient-doctor consultations through tele-medicine platforms will facilitate relationship continuity and enable a physician to provide care to patients remotely.
  • Home Care Medical Devices & Wearables: Data from medical devices and wearables enables the healthcare providers to remotely monitor patients and take timely and proactive action for improved care delivery.


Challenges in Continuity of Care

While there are significant benefits of the continuity of care approach, there are a few challenges that we need to recognize.

  • Relationship continuity is dependant on having access to a particular physician when required. Patients with an urgent problem are often prepared to trade off waiting to see a physician with whom they have a good relationship in favour of an unknown physician.
  • In several cases, patients are willing to sacrifice “continuity of care” and are acceptable to consult with a doctor other than their usual GP. These include:

1. Patients with acute problems (like a chest infection), don’t really care which doctor they see. They are looking for someone who can see them in a timely fashion and will treat them.
2. Need specialised care from another member of the team
3. Wish to discuss a problem they find embarrassing to discuss with their regular doctor
4. Chose to consult a GP of the same gender

  • There are studies to suggest that a fresh start with a new doctor might open new diagnostic perspectives.
  • Seeing the same doctor might not guarantee a good relationship.
  • Patient-doctor relationship continuity might encourage collusion (for e.g., wrongfully getting a sickness certification)
  • Continuity of care can decrease communication if doctor or patient assumes they know (or are known by) the other so well that new issues are not introduced or discussed.


“Continuity of Care” does not necessarily mean that the patient will consult with the same doctor each time. This might not be possible. In such cases, we will need to ensure continuity using technology and services of other clinicians in the network. When it comes to continuity, the patients are really looking for the following:

  • They do not have to repeat details of their history and condition each time they meet a new clinician
  • They are not repeatedly handed over from one clinician to another and no one seems to be responsible
  • They are not subjected to unnecessary medication and investigations
  • They do not fall between the cracks as they transition from one treatment setting to another
  • They do not receive conflicting opinions from different clinicians

We need to ensure that the patient does not experience the above.

However, we should endeavour to provide “Continuity of Care” through the same doctor during an “episode of care” (healthcare services for a specific medical problem, condition or illness) for each patient.

At iKure, “Continuity of Care” is a key focus area and our primary healthcare delivery model is built around this theme. For us, continuity of care involves integrating patient care in his home with our Clinic services through the following:

  • our network of Hub & Spoke clinics
  • regular health intervention programs in the community
  • trained frontline health workers for last mile connectivity
  • our proprietary population health management system
  • integration with medical devices and wearables
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