Priya Kotwani - Academia.edu (original) (raw)

Papers by Priya Kotwani

Journal of the Association of Physicians of India

Cureus

Longstanding hyperlipidemia can increase the risk of cardiovascular disease. Statins are currentl... more Longstanding hyperlipidemia can increase the risk of cardiovascular disease. Statins are currently the mainstay of treatment in hyperlipidemia. Combination therapy of statin with ezetimibe is only indicated for severe hypercholesterolemia and very high-risk atherosclerotic cardiovascular disease (ASCVD) population. There is a paucity of studies comparing statin monotherapy vs combination therapy with ezetimibe. This study aims to perform a meta-analysis of the existing literature and compare the effectiveness of statin monotherapy with statin-ezetimibe combination therapy in the management of hyperlipidemia. A systematic electronic search of the scientific literature was performed in PubMed, EMBASE, and Scopus. Only randomized controlled trials comparing simvastatin monotherapy vs simvastatin-ezetimibe combination therapy between the years 2000 and 2021 and published in English language were included. Fifteen studies were included in the final analysis. The main outcomes that were compared were a reduction in low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Our study showed that combination therapy led to a higher reduction of LDL-C (Mean difference:-20.22(-26.38,-14.07); P<0.0001) compared to monotherapy with a statin alone. There was no significant difference in the reduction of HDL-C values (Mean difference:-0.07(-0.45,0.32); P-0.04) between the two groups. Our study indicates that the combination therapy of simvastatin and ezetimibe is more effective in reduction of LDL-C levels compared to simvastatin monotherapy alone. Currently, guidelines recommend combination therapy only for severe hypercholesterolemia and high-risk ASCVD patients, more studies are needed to study the effectiveness of simvastatin-ezetimibe combination therapy in low-risk ASCVD population.

Frontiers in Public Health

Background and objectivesAlthough a relatively recent concept for developing countries, the devel... more Background and objectivesAlthough a relatively recent concept for developing countries, the developed world has been using League Tables as a policy guiding tool for a comprehensive assessment of health expenditures; country-specific “League tables” can be a very useful tool for national healthcare planning and budgeting. Presented herewith is a comprehensive league table of cost per Quality Adjusted Life Years (QALY) or Disability Adjusted Life Years (DALY) ratios derived from Health Technology Assessment (HTA) or economic evaluation studies reported from India through a systematic review.MethodsEconomic evaluations and HTAs published from January 2003 to October 2019 were searched from various databases. We only included the studies reporting common outcomes (QALY/DALY) and methodology to increase the generalizability of league table findings. To opt for a uniform criterion, a reference case approach developed by Health Technology Assessment in India (HTAIn) was used for the repor...

Journal of Datta Meghe Institute of Medical Sciences University

Background: The Health and Family Welfare Department of Gujarat implemented a mHealth Programme c... more Background: The Health and Family Welfare Department of Gujarat implemented a mHealth Programme called TeCHO+ (Technology for Community Health Operations) in 2018. TeCHO+ is aimed at making progress across all dimensions of the comprehensive primary healthcare services. Objective: The objective of this study is to record the document rollout and early implementation experience of TeCHO+ programme in Gujarat. Methods: The present participatory process documentation exercise was undertaken in Gujarat. The various steps for process documentation were decided after participation in multiple task force meetings and state/district‐ and taluka‐level action seminars and reviewing the TeCHO+ programme data and progress reports. The perceptions of the health officials and field staff were gathered using key informant interviews from five districts of Gujarat: Bharuch, Narmada, Gandhinagar, Mahisagar, and The Dangs. In addition, stakeholders involved with TeCHO+ Programme were interviewed to u...

BMJ Innovations

The Health and Family Welfare Department, Government of Gujarat, is implementing a program named ... more The Health and Family Welfare Department, Government of Gujarat, is implementing a program named Technology for Community Health Operation or TeCHO+ addressing state’s priority health issues. This program envisages replacing the existing mother and child tracking system or e-Mamta application in the state. This program is based on ImTeCHO—Innovative Mobile Technology for Community Health Operations—which was piloted in Jhagadia, Bharuch district of Gujarat in 2013. The program showed improvements not only in terms of coverage of maternal and newborn care packages averting malnutrition but also was cost-effective. This paper details the protocol for health technology assessment to assess the impact of TeCHO+ program on data quality, improvement in service delivery coverage, reduction in morbidity and mortality as well as assess the cost-effectiveness. The study will be conducted in five districts of the state. A mixed-method approach will be adopted. Data will be validated in a phase...

Frontiers in Public Health, 2021

Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-l... more Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-lead portable ECG devices across all primary health centers (PHC) in the district to screen cardiac abnormalities among high-risk and symptomatic adults for providing primary management and proper timely referral. The prime purpose of the study was to assess the cost-effectiveness of portable ECG for the screening of cardiovascular diseases (CVD) among high-risk and symptomatic adults at the PHC in Ahmedabad, Gujarat. Methods: Cost-effective analysis was conducted using a societal perspective. An incremental costing approach was adapted, and cost-effectiveness analysis was done using a decision-analytic model. We surveyed 73 patients who screened positive for cardiac abnormality, documented the type of ECG abnormalities, and diagnosed CVD. The program cost was obtained from the implementers. Transition probabilities were derived from primary data supported by expert opinion for the interv...

Abstract Background: Emerging adulthood is a critical stage of life with a fe... more Abstract Background: Emerging adulthood is a critical stage of life with a feeling of ambiguity through their transition from adolescence to adulthood. The transition in this life stage poses various mental health challenges to the individuals. The mental health of the emerging adults may worsen in times of ongoing COVID-19 pandemic. The study aims to compare the COVID- 19 and lockdown associated psychological distress among emerging adults and adults. Material and Methods: A cross-sectional, observational study was performed in India. We used the snowball sampling technique and the data was collected using an online selfdesigned semi-structured questionnaire and the findings from 112 emerging adults with 112 adults were compared. Results: The mean score for psychological distress was 14.69 among emerging adults, while it was 11.12 for...

Journal of Communicable Diseases, 2021

Background: COVID-19 has financially burdened Government’s healthcare system as well as household... more Background: COVID-19 has financially burdened Government’s healthcare system as well as households with COVID-19 patients. Present study aims to value the out-of-pocket expenditure and health-related quality of life (HRQOL) using EQ-5D-5L among COVID-19 patients who sought treatment in COVID-19 center of a tertiary hospital in Vadodara, Gujarat. Methods: The present analysis is a prospective real-world study. The questionnaire included socio-demographic data, health status, out-of-pocket expenses associated with treatment of COVID-19, and EQ-5D-5L scale. The relationships of all factors and the scores of EQ-5D-5L were analyzed. All costs are reported in Indian Rupees and then converted to US dollars. Result: Out of total 138 participants included in the study, 108 (78.3%) participants had mild to moderate symptoms of COVID-19 infection and were admitted to COVID Care Centre (CCC) while 30 (21.7%) patients had severe disease and were admitted to COVID Intensive Care Unit (ICU). Mean ...

The world is concerned about managing COVID-19 pandemic and its consequences. The COVID-19 has no... more The world is concerned about managing COVID-19 pandemic and its consequences. The COVID-19 has not only affected physical health and the economy but impacted the mental health of people globally. It has created a parallel epidemic of psychological distress. Experts envision a gigantic influx of patients needing mental health care, with needs far greater than the nation's existing public health systems can deal with. This paper discusses Indian scenario of mental health issues fueled by COVID-19 pandemic and strategies to address mental health emergency by adopting unconventional sustainable measures and formally integrating mental health into public health preparedness and emergency response plans of the country.

Journal of Family Medicine and Primary Care, 2021

Background: Coronavirus disease-2019 (COVID-1) 9 pandemic is spreading like a wildfire across the... more Background: Coronavirus disease-2019 (COVID-1) 9 pandemic is spreading like a wildfire across the globe. For its containment, measures such as isolation and quarantine are followed. The patients tested positive for COVID-19 disease are kept in isolation with no interaction with the family members leading to negative mental health consequences. To address this, Parul Sevashram Hospital adapted to a more holistic approach to treatment. Methodology: A process documentation of the best practices was undertaken. Key Informant Interviews (KIIs) were used to gather responses of the project implementers (n = 2), physiotherapists (n = 2), dietician (n = 1), Ayurveda practitioners (n = 2), and staff nurses (n = 2) who were mainly involved in tailoring the package of services to be offered as well as their implementation. In addition, KIIs were also conducted with the patients (n = 10) their views on the additional package of services offered to them and the overall level of satisfaction with the care. Findings: The holistic care services involved diet therapy, physiotherapy and yoga, AYUSH medicines for boosting immunity, music therapy and books and indoor games. Few implementation challenges include convincing healthcare workers for providing care to COVID patients, availing raw materials for preparing AYUSH medicines during lockdown. Trainings were also provided to HCW on infection control practices, provided monetary incentive and mobilised the existing resources for addressing the challenges. Conclusion: The holistic care has potential influence on patient's mental health, recovery rate, and satisfaction of COVID-19 patients. These approaches can be up-scaled with a minimum investment and has a potential to benefit patients both in public and private hospitals.

Journal of Family Medicine and Primary Care, 2021

Background and Objectives: The Dastak Abhiyan is an Initiative of Government of Madhya Pradesh wh... more Background and Objectives: The Dastak Abhiyan is an Initiative of Government of Madhya Pradesh which was pilot tested in November 2016 and showed promising outcomes. This campaign deals with active case finding house to house for Diarrhea, Pneumonia, Severe Acute Malnutrition, Severe Anemia and their treatment and referral by the Dastak Team comprising of Auxiliary Nurse Midwife, Accredited Social Health Activist, and Anganwadi Worker. In this study, we attempted to assess the availability of the drugs and necessary commodities, before the commencement of Abhiyan to frontline health workers and beneficiariesâ€™ response towards this initiative in 4 districts of Madhya Pradesh viz. Jhabua, Sheopur, Raisen, and Bhopal. Methods: The study used modified WHOâ€™s 30 cluster sampling technique and 7 households in each village were selected for assessment of beneficiary satisfaction and officials at District, Block and Auxiliary Nurse Midwives were interviewed to assess the preparedness of ...

Background: HAIs impart a huge clinical and economic burden in India. Healthcare worker’s complia... more Background: HAIs impart a huge clinical and economic burden in India. Healthcare worker’s compliance to hand hygiene protocol can play an important role in preventing the transmission of cross-infection and thus reducing the HAIs. Over last few years, there has been a wide use of ultraviolate (UV) based fluorescent markers for assessing quality of hand hygiene. This Health Technology Assessment (HTA) study will be conducted with the aim to identify low cost, easy and feasible strategy having potential to get integrated in the current health system to deal with issue of HAI in ICU settings.Methods: The study will be conducted in three phases. The impact of innovation on hand hygiene compliance will be assessed quantitatively by undertaking meta-analysis of secondary literature on UV based imaging tool in improving hand hygiene compliance in ICUs. Following this, the feasibility of using this innovation in developing country like India will be assessed. Decision Analytic modelling wil...

Journal of Dental Research and Review, 2020

International Journal of Technology Assessment in Health Care, 2020

IntroductionWeb-based and mobile health interventions, also called eHealth, have significant pote... more IntroductionWeb-based and mobile health interventions, also called eHealth, have significant potential to deliver cost effective, quality health care. The present review maps common eHealth technology solutions for primary healthcare by evaluating their safety, efficacy, and effectiveness, and the challenges associated with their implementation in low-middle income countries (LMIC) in the last ten years.MethodsA search of various electronic database was conducted, including PubMed, Scopus, and PsycINFO, to identify articles published between 2009 and 2019 that focused on the implementation of eHealth in the primary healthcare setting across LMICs. A total of 450 articles were screened and thirty-nine relevant articles were selected for review.ResultsThe thirty-nine included studies were classified into the following four categories: (i) assessment of intervention effects (n = 26); (ii) cost-benefit analysis (n = 4); (iii) systematic review (n = 5); and (iv) conceptual exploration of...

International Journal of Technology Assessment in Health Care, 2020

IntroductionIndia has introduced health technology assessment (HTA) as a tool for improving the a... more IntroductionIndia has introduced health technology assessment (HTA) as a tool for improving the allocation of health resources. The core mandate of HTA in India (HTAIn) is to undertake critical appraisal of available technologies, identify cost-effective interventions, and help the government pursue evidence-informed decisions regarding public health expenditures. We conducted a systematic review to assess economic evaluation studies published in the last four years from India.MethodsEconomic evaluations published from September 2015 to September 2019 were identified by searching various databases, including PubMed, Scopus, Embase, The Cochrane Library, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Cost-effectiveness studies and HTAs reported or conducted in India were included. Two independent reviewers performed the final selection of studies by assessing the full-text articles and conducted the data extraction. Differenc...

International Journal of Technology Assessment in Health Care, 2020

IntroductionThe Health and Family Welfare Department of the Government of Gujarat is implementing... more IntroductionThe Health and Family Welfare Department of the Government of Gujarat is implementing a program called Technology for Community Health Operation (TeCHO+) to address the state's priority health issues. This paper details the protocol for using health technology assessment to assess the impact of the TeCHO+ program on data quality, service delivery coverage, rates of morbidity and mortality, and cost effectiveness.MethodsThis mixed-method study will be conducted in five districts. Data will be validated in a phased manner over a three-year period, along with an assessment of key outcome indicators. Additionally, key informant interviews will be conducted and cost data will be gathered.ResultsEarly implementation of TeCHO+ has highlighted mixed impact at an operational level, with gaps in implementation. Despite some gaps in the available evidence, TeCHO+ solutions can significantly improve health service delivery through increased accuracy of data management, high-risk...

Journal of the Association of Physicians of India

Cureus

Frontiers in Public Health

Journal of Datta Meghe Institute of Medical Sciences University

BMJ Innovations

Frontiers in Public Health, 2021

Journal of Communicable Diseases, 2021

Journal of Family Medicine and Primary Care, 2021

Journal of Dental Research and Review, 2020

International Journal of Technology Assessment in Health Care, 2020