Innovative model of tele-mentoring to increase access for Specialist care in Addiction and Mental

Health: VKN NIMHANS Chhattisgarh ECHO

Dr. Bhavya K Bairy, Mrs. Kanika Mehrotra, Ms. Sandeepa Kaur, Mr. Aurobind Ganesh, Dr. Malathesh BC, Dr. Mallikarjun Rao Sagi, Dr. Prabhat Kumar Chand

Project VKN Chhattisgarh IMA ECHOVirtual Knowledge Network (VKN)Team, NIMHANS

Abstract ID Number is RM2018-O-0019

(mhGAP WHO 2014)

Problem definition / Issue Identified

● In Chhattisgarh, 11.7% of the population is affected with psychiatric disorder

● Glaring treatment gap

● Only eleven psychiatrists, two psychiatric social workers and one clinical psychologist

available per crore of population (NMHS, 2016)

● Major hindrance in successful implementation of District Mental Health Programme

(DMHP) in Chhattisgarh.

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Virtual Knowledge Network (VKN) NIMHANS ECHO

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VKN

Patient Centric

Technology

Periodic

Best Practices

Suggested Solution● Virtual Knowledge Network (VKN) ECHO model started its Pilot mission

in April 2014

● Awarded “Good, Replicable and Innovative Practice” by National Health Mission, Government of India in 2016

● Following this, NHM Chhattisgarh approached VKN to train and handhold their medical officers and counsellors in the area of mental health

● This gave birth to Chhattisgarh IMA ECHO to train these health providers

Application / Model employed

● “Project VKN Chhattisgarh ECHO” started in August 2017 on “Integrated Mental Health

and Addiction (IMA)” with the objective of capacity building for “Best Psychiatry

practices” in all 27 districts of Chhattisgarh through “HUB and SPOKES” model

● Each tele-ECHO clinic - didactic and case based learning, integrated with e-learning

assignments

11

Recommendation (shared by secured mobile platform to remote treating doctor/counselor)

Blended Certification & Accreditation : Mobile learning

Course completion criteria

● Minimum 60% attendance in the sessions

● Completing pre-test and periodic post-tests

● 80% cut off score (5 attempts) in all assignments

● Sending monthly reports

● Linked to certification of these doctors and counsellors from NIMHANS

● Continuous handholding through Super Friday econsult where they

discussed difficult cases with Expert Hub team.

Results / Take Away from the Paper - about participants

● Under this Project, 12 doctors have been accredited● Average age of the doctors trained was 37 years and all were males● Years of service as MO

● Average attendance (%) - 80.1%● No of participants who attended >60% of sessions - 12● Presented 6 or more cases● All assignments cleared with > 80% score with 5 attempts● Improvement in overall confidence level from 6/10 to 9/10

0 - 5 years 5 - 10 years 10 - 15 years >15 years

3 MOs 4 MOs 3 MOs 2 MOs

Public health impact

● More than 200 patients were discussed

● About 123 patients were co-managed in live sessions in this program

● Around 78 Patients were co-managed through Super Friday e-consultation

Diagnosis No of cases

Psychosis 23

Bipolar disorder 5

Depressive disorder 31

Anxiety disorders 20

OCD 7

Somatoform disorder 4

Substance use 28

Miscellaneous (Epilepsy, Dementia)

5

Super Friday e-consultationLive session case discussions

Diagnosis No of cases

Psychosis 21

Bipolar disorder 7

Depressive disorder 11

Anxiety disorders 8

OCD 4

Somatoform disorder 0

Substance use 16

Dementia 3

Epilepsy 2

Misc. (MLC, marital problems, delirium, disability assessment)

3

Reach to Community

● The force multiplier effect through seamless engagement in developing knowledge networks and learning loops between rural areas of Chhattisgarh and NIMHANS has led to 30 doctors and 30 counsellors being engaged with us in various training programs

● Around 26500 patients were treated by these doctors and 13500 patients were provided counselling services by the counsellors

● In order to bridge the treatment gap in remote and underserved areas of the country, this model can be replicated all over India by establishment of multiple local Hubs with NIMHANS as the SuperHub to supervise them

DMHP

DMHP

DMHP

DMHP

DMHP

DMHP

DMHP

DMHP

Lessons Learnt

• Feasible in exponentially increase in the Skilled Capacity

• Cost effective way of “Knowledge diffusion” and building a “virtual Community of experts”

• Benefit is translating the “best practices” to the Community

• Can be delivered through simple “Smartphone”

● Continued motivation and engagement from the community health providers

● Need of dedicated team of multidisciplinary experts, IT expert, Learning Co-ordinator & Outcome evaluator

● Depends heavily on Internet like 4G or Broadband

Challenges

In News

THANK YOUvlc.nimhans.ac.in

nimhansdigitalacacemy.inbhavyabairy@gmail.combhavya@vknnimhans.in