RESEARCH

WHAT IS PEPPS?

BACKGROUND

Primary Care Physicians, by virtue of their function as gate-keepers of healthcare, are key to implementing pre-emption or primary-prevention. However, routine integration of primary prevention into every day clinical practice has been sub-optimal, resulting in lost opportunities to decrease morbidity and mortality. Even in the United States, despite the Preventive Services Task Force recommending that preventive services be a part of every medical visit, studies report a compliance rate of only 20% to 60%. With the exponential increase in the prevalence of Non Communicable Diseases (NCDs) in Emerging Economies like South Asia countries, China, etc., particularly cardio-metabolic diseases, which is taking a staggering medical, social and economic toll by disproportionately affecting the younger population, primary prevention of NCDs has become the public health priority.

The near-term goal of this study is a web-based practice tool to facilitate physician-delivered primary prevention to those with early risk factors and border-line high biomedical markers, which stratify them to be in the “pre-disease,” state, (e.g., pre-diabetes, pre-hypertension, etc.,) as classified by respective medical societies. The practice tool will assist physicians in prioritizing diagnoses of pre-disease conditions while making it a practice habit to deliver evidence-based behavioral/nutritional recommendations at the time of the clinic visit. An integrated practice tool focusing on pre-disease pre-emption could advance the physician’s practice profile, while positively influencing patients and family members to view clinic visits as opportunities to screen for pre-disease and receive preemptive recommendations from the physician to maintain health.

METHODOLOGY: Facts (Epidemiology and Perceptions)

When developing such a tool, sole reliance on past studies from the west is not advised, as perceptions in one setting may not be generalizable to another. A country-wide formative assessment is necessary to identify perceptions and compile facts on epidemiology of pre-disease states presenting to the primary care clinic setting. Additionally, current practice patterns amongst the study audience of CPs and GPs as it relates to managing pre-disease or implementation of primary prevention strategies needs to be complied, before any practice tool can be developed and introduced. PEPPS will be the first and largest study of its kind to report on the baseline status of primary prevention practices in clinic settings in Emerging Markets.

3-STEP METHOD:
The framework for this study is based on continuous and incremental progression of data inputs and ideas. Because the concept of pre-disease is rather novel in Emerging Countries, the framework of PEPPS, therefore needs to include education on pre-disease diagnoses as well as on evidence-based solutions, while gathering epidemiological and perceptions’ data about the individual physician’s clinical practice.

Step 1: CONTENT DEVELOPMENT by GLOBAL EXPERTS
Physician formative involvement in the practice-based pre-disease management solutions began with the convening of a high level group of peer-identified Global Physician Opinion Leaders by The PreDisease Forum, whose primary aim is to advance awareness, education and research on pre-disease states. The experts will develop digital educational content based on their vast experience and knowledge of evidence-based behavioral/nutritional solutions to influence their peers. The digital program will be interspersed with related survey questions for the study. The entire program will take between 20-25 minutes to complete.

Step 2: SAMPLE SELECTION & STUDY EXECUTION
12,000 Primary Care Physicians will be included in the study. The study will be made available online and email and mailer invitations will be sent to community-based clinics informing them about the online PEPPS program and study, which will be accessible on-demand at their convenience. The duration of the study will be for 30 calendar days. Study participants will be required to execute an online study agreement. After the study period, data will be complied and analyzed by The PreDisease Forum’s Physician Opinion Leaders. The manuscript will be prepared for publication.

Step 3: PRACTICE-INTEGRATED TOOL DEVELOPMENT & DISSEMINATIOIN
Approximately 10% of the study participants are expected to be interested in further formative involvement. These physicians will be fully engaged with The Advanced Leadership Program in Pre-Disease Management with the Global Physician Opinion Leaders from The PreDisease Forum in the development of the practice integrated tool and will convene at live symposia in New Delhi (2016) and Abu Dhabi (2017) to discuss the study findings and ideas of disseminating the tool to peers within their influence.