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Kirpekar V, Faye A, Bhave S, Gawande S, Tadke R. District mental health program: Then and now. Indian J Psychiatry 2024; 66:603-613. [PMID: 39257501 PMCID: PMC11382743 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_974_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 09/12/2024] Open
Abstract
District Mental Health Program (DMHP) is part of the broader National Mental Health Program (NMHP) launched in 1982. In India, DMHP has evolved over the years, moving from a pilot project to an integrated component of the NMHP. Efforts have been made to expand services, protect the rights of individuals with mental illness, and integrate mental healthcare into the primary healthcare system. Recent updates and efforts taken by the Government of India and state governments (60% and 40% budget share respectively) have improved the quality of services provided under DMHP. With the increasing use of the internet and mobile technology, DMHP has spread its arena of services more deeply and widely in the last few years reaching up to 738 districts in the country. However, there is still work to be done to address many challenges associated with mental health in India though the recent developments seem promising as a substantial number of patients are now having access to the programme. This narrative review is the summary of information available to date on the evolution of implementation and expansion of DMHP over the years and provides a gist of the positive aspects as well as limitations of the DMHP witnessed in recent years.
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Affiliation(s)
- Vivek Kirpekar
- Department of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
| | - Abhijeet Faye
- Department of Psychiatry, DMIHER, Datta Meghe Medical College, Wanadongri, Nagpur, Maharashtra, India
| | - Sudhir Bhave
- Department of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
| | - Sushil Gawande
- Department of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
| | - Rahul Tadke
- Department of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
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Jensen LX, Buhl A, Hussain S, Karan A, Konradsen F, Bearman M. Digital education for health professionals in India: a scoping review of the research. BMC MEDICAL EDUCATION 2023; 23:561. [PMID: 37559028 PMCID: PMC10410828 DOI: 10.1186/s12909-023-04552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND The World Health Organization (WHO) predicts a global shortfall of 18 million health workers by 2030, particularly in low- and middle-income countries like India. The country faces challenges such as inadequate numbers of health professionals, poor quality of personnel, and outdated teaching styles. Digital education may address some of these issues, but there is limited research on what approaches work best in the Indian context. This paper conducts a scoping review of published empirical research related to digital health professions education in India to understand strengths, weaknesses, gaps, and future research opportunities. METHODS We searched four databases using a three-element search string with terms related to digital education, health professions, and India. Data was extracted from 36 included studies that reported on empirical research into digital educational innovations in the formal health professions education system of India. Data were analysed thematically. RESULTS Most study rationales related to challenges facing the Indian health care system, rather than a wish to better understand phenomena related to teaching and learning. Similarly, most studies can be described as general evaluations of digital educational innovations, rather than educational research per se. They mostly explored questions related to student perception and intervention effectiveness, typically in the form of quantitative analysis of survey data or pre- and post-test results. CONCLUSIONS The analysis revealed valuable insights into India-specific needs and challenges. The Indian health professions education system's size and unique challenges present opportunities for more nuanced, context-specific investigations and contributions to the wider digital education field. This, however, would require a broadening of methodological approaches, in particular rigorous qualitative designs, and a focus on addressing research-worthy educational phenomena.
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Affiliation(s)
- Lasse X Jensen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Bdg. 9, Copenhagen K, 1353, Denmark.
| | - Alexandra Buhl
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Bdg. 9, Copenhagen K, 1353, Denmark
| | | | - Anup Karan
- Public Health Foundation of India, New Delhi, India
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Bdg. 9, Copenhagen K, 1353, Denmark
- Novo Nordisk Foundation, Copenhagen, Denmark
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
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Bessell E, Kim JS, Chiem L, McDonald A, Thompson D, Glozier N, Simpson A, Parcsi L, Morris R, Koncz R. Effectiveness of Project ECHO Programs in Improving Clinician Knowledge and Confidence in Managing Complex Psychiatric Patients: a Waitlist-Controlled Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:25-34. [PMID: 36085406 PMCID: PMC9883324 DOI: 10.1007/s40596-022-01701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The authors aimed to determine if Project Extension for Community Healthcare Outcomes (ECHO), a health-education model utilising teleconferencing technology, improves the capacity of clinicians in assessing and managing complex psychiatric patients. METHODS Three pilot Project ECHO programs were evaluated as a prospective waitlist-controlled trial, focusing on Adult Eating Disorders, Adult Intellectual Disability Mental Health, and General Mental Health. Each program comprised 9-10 weekly teleconferencing group sessions. Participants and waitlist-controls completed pre- and post-program surveys. The primary outcomes were self-reported knowledge and confidence in assessing and managing complex patients relevant to each group. Linear mixed models were used to assess the group-by-time interaction, or change over time, as appropriate. RESULTS Between July 2020 and June 2021, three series of the Adult Intellectual Disability Mental Health program, two series of the Adult Eating Disorders program, and two series of the General Mental Health program were delivered. Compared to waitlist-controls (n = 21), there were statistically significant improvements in self-reported knowledge and confidence for all topics amongst participants of the Adult Eating Disorders program (n = 44). In the Adult Intellectual Disability Mental Health program, there were significant improvements in self-reported knowledge and confidence amongst participants (n = 67) for most topics compared to controls (n = 21). There were no waitlist-controls for the General Mental Health program, but within-group analysis (n = 28) showed significant improvements in participants' knowledge and confidence following program completion, compared to baseline. CONCLUSION Project ECHO is a feasible and effective model to develop workforce capacity in managing complex psychiatric conditions.
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Affiliation(s)
| | - Ji Sun Kim
- Sydney Local Health District, Sydney, NSW, Australia
| | - Lyn Chiem
- Sydney Local Health District, Sydney, NSW, Australia
| | | | | | | | | | - Lisa Parcsi
- Sydney Local Health District, Sydney, NSW, Australia
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Gajera GV, Pandey P, Malathesh BC, Nirisha PL, Suchandra KHH, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Suresha BM, Jain S. Effectiveness of blended versus fully digital training in primary care psychiatry: A retrospective comparison from India. J Neurosci Rural Pract 2023; 14:91-97. [PMID: 36891122 PMCID: PMC9945417 DOI: 10.25259/jnrp-2022-4-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives We compared effectiveness of blended mode (consisting of traditional classroom teaching and e-learning sessions) and fully digital mode (e-learning sessions alone) of primary care psychiatry training for primary care doctors in Chhattisgarh. Materials and Methods We retrospectively compared the engagement in training, knowledge (K), attitude (A), and practice (P) in primary care psychiatry, and patient identification by primary care doctors (n = 941) from Chhattisgarh region who underwent training through either blended training mode (n = 546) or fully digital training mode (n = 395) for 16 h each, using Clinical Schedules for Primary Care Psychiatry based modules between June 2019 and November 2020 with a tertiary care center (NIMHANS, Bengaluru) as hub. Statistical Analysis The Statistical Package for the Social Sciences version 27 was used to analyze the data. Continuous variables were analyzed using the independent samples t-test, and discrete variables were analyzed using the Chi-square test. A repeated measures analysis of variance (ANOVA) (two-way mixed design) was used to see the interaction of training type and time of pre- and post-KAP measurement while controlling for years of experience. The number of patients identified by both training groups over 8 months was also compared using the repeated measures ANOVA (two-way mixed design). Results Engagement inferred by the number of participants completing pre-KAP forms (75%), post-KAP forms (43%), post-session assessments (37- 47%), case presentation (33.9%), and certification (32.1%) was better in the blended group (P < 0.05). The mean gain in KAP scores was significantly higher in the blended group controlling for the years of experience as primary care doctor (PCD) (F = 30.36, P < 0.001). PCDs in the blended training group consistently identified a higher number of patients with mental illness over 8 months of follow-up (F = 6.21, P < 0.001). Conclusion The blended mode yielded better results in primary care psychiatry training compared to fully digital mode. In-person interactions while provided for a very brief proportion of the training seem to have an unmistakable imprint on the outcomes and seem critical for better consolidation and assimilation of information, which translates into better practice.
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Affiliation(s)
- Gopi V. Gajera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Barikar C. Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - P. Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K. Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ferose Azeez Ibrahim
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Bada Math Suresha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sumi Jain
- Department of Non-Communicable Diseases, National Health Mission, Chhattisgarh, India
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Nirisha PL, Malathesh BC, Kulal N, Harshithaa NR, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Parthasarathy R, Manjappa AA, Thirthalli J, Chand PK, Arora S, Math SB. Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training. Community Ment Health J 2023; 59:175-184. [PMID: 35779139 PMCID: PMC10290774 DOI: 10.1007/s10597-022-00996-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0·01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.
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Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Barikar C Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, India
| | - Nithesh Kulal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nisha R Harshithaa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - N Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Adarsha Alur Manjappa
- DMHP Psychiatrist, Department of Health and Family Welfare, Government of Karnataka Office of the District Health Officer, Ramanagara District, Ramanagara, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Arora
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Etling MA, Vik TA, Janota AD, Liang KL, Kryder‐Reid CL, Robertson M, Scanlon C, Carson A, Agley J, Severance TS. The continuing evolution of a cancer prevention, screening, and survivorship
ECHO
: A second year of implementation. Cancer Med 2022; 12:7398-7405. [PMID: 36504440 PMCID: PMC10067045 DOI: 10.1002/cam4.5441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION An estimated 39,010 Indiana residents were diagnosed with cancer in 2021. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non-specialists. Due to positive outcomes from the pilot year, the Cancer Prevention, Screening, and Survivorship ECHO was implemented for a second year. The purpose of this study was to measure the participation and regional impact of this ECHO. METHODS ECHO sessions occurred twice monthly from October 2020 to October 2021. Changes were implemented in response to feedback from the pilot year, including making the curriculum more practical for learners and adding accreditation opportunities. Participant information and feedback was extracted from electronic surveys for review. RESULTS There were 24 ECHO sessions with 213 unique participants, increased from 140 unique participants in the pilot year. An average of 23.5 individuals attended each session, increased from 15.5 individuals per session. Enrolled participants served in a diverse set of roles and represented 247 zip codes, 30 Indiana counties, and 32 states across the United States, each of which increased from the pilot year. DISCUSSION In this second year, this ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback-driven curriculum design. Cancer care is multi-disciplinary, with health educators, nurses, and administrators, each acting within the cancer care continuum. As a result, this ECHO has been adapted to serve an increasingly broad distribution of professionals. CONCLUSION The second year of the Cancer Prevention, Screening, and Survivorship ECHO displayed increased overall enrollment and participation, greater diversity among participant roles, and a wider reach across Indiana and the United States.
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Affiliation(s)
- Mary Ann Etling
- Indiana University School of Medicine Indianapolis Indiana USA
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Terry A. Vik
- Indiana University School of Medicine Indianapolis Indiana USA
- Riley Hospital for Children Indianapolis Indiana USA
- Riley Hospital Division of Pediatric Hematology Oncology Indianapolis Indiana USA
| | - Andrea D. Janota
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Kaley L. Liang
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | | | - Mary Robertson
- Indiana Cancer Consortium Indianapolis Indiana USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center Indianapolis Indiana USA
| | | | - Anyé Carson
- Indiana University Richard M. Fairbanks School of Public Health Indianapolis Indiana USA
| | - Jon Agley
- Indiana University School of Public Health Bloomington Indiana USA
- Prevention Insights Bloomington Indiana USA
| | - Tyler S. Severance
- Indiana University School of Medicine Indianapolis Indiana USA
- Riley Hospital for Children Indianapolis Indiana USA
- Riley Hospital Division of Pediatric Hematology Oncology Indianapolis Indiana USA
- Department of Child Health University of Missouri School of Medicine Columbia Missouri USA
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Girase B, Parikh R, Vashisht S, Mullick A, Ambhore V, Maknikar S. India's policy and programmatic response to mental health of young people: A narrative review. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chang O, Ryan B, Liebetrau E, Robertson P. Piloting online training in the Pacific-Ophelia project for child and adolescent mental health. Asia Pac Psychiatry 2022; 14:e12510. [PMID: 35174630 DOI: 10.1111/appy.12510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/01/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION In June 2020, St Vincent's Mental Health, Fiji National University, and the Royal Australian and New Zealand College of Psychiatrists, Faculty of Child and Adolescent Psychiatry collaborated to deliver online, specialized child and adolescent mental health (CAMH) training to Pacific-based healthcare workers. This accompanying research aimed to understand the telehealth model and structures that would sustain an engaged community of practice and support the development of professional networks across the Pacific. METHOD Quantitative and qualitative feedback was analyzed to understand participation and self-rated measures of skills, knowledge, and confidence in providing health care for children and young people, as well as experiences of training, including access, engagement, and applicability of the initiative to the Pacific Islands health care organizations. RESULTS Ophelia Training was able to meet the stated learning objectives. The data from all stakeholders identifies the value of a telehealth initiative incorporating training, technical assistance, knowledge networks, and professional coaching as a capacity building approach. CONCLUSION This program offers an integration of research and practice. This regional approach to understanding telehealth capacity for Pacific Island mental health services is valuable for informing decision-making with respect to clinical care, management, workforce training and policy. It also provided an opportunity to improve health inequalities, by improving access to CAMH training via telehealth.
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Affiliation(s)
- Odille Chang
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Brigid Ryan
- St. Vincent's Mental Health, St. Vincent's, Melbourne, Australia
| | - Elaine Liebetrau
- Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
| | - Paul Robertson
- Mindful, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Nair S, Sinha P, Chand P, Sahu P, Gorthi NV, Varghese M, Sivakumar PT. Extension for Community Healthcare Outcomes Based Telementoring of Physicians for Dementia-Effectiveness in India. Front Psychiatry 2022; 13:869685. [PMID: 35677870 PMCID: PMC9168648 DOI: 10.3389/fpsyt.2022.869685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate the effectiveness of a program based on the telementoring model [Extension for Community Healthcare Outcomes (ECHO)] for primary care physicians in diagnosing and treating patients with dementia. METHOD The ECHO model was adapted through 12 live sessions of 2 h every 2 weeks consisting of a didactic presentation by the expert, peer-led new case discussions, and follow-up discussions. In addition, there were 10 h of self-paced e-learning and interim assignments. The impact was examined by noting participation, session ratings, monthly clinical reports, and comparing knowledge and competency scores before and after the course. RESULTS Among the 63 participants, 39.7% attended at least 80% of the sessions; completing the program successfully. The ratings for all sessions ranged from "good" to "excellent." The paired sample t-test revealed a statistically significant improvement (p < 0.001) in self-rated skills and confidence in diagnosing and treating dementia with an effect size of 1.25 and 1.37, respectively. No change in the knowledge score was observed throughout the course. A considerable increase in dementia-related clinical practice was observed during four monthly summary of clinical cases. Due to the limited data of monthly reports during the COVID pandemic, no statistical analysis was attempted. CONCLUSION The ECHO model appears to have a positive immediate impact on the clinical ability of primary care physicians to diagnose and treat dementia. Its direct impact on patient health and at the community level should be aimed at in future studies.
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Affiliation(s)
- Shruti Nair
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabhat Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prashant Sahu
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Naga Vss Gorthi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - P T Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Malathesh BC, Bairy BK, Kumar CN, Nirisha PL, Gajera GV, Pandey P, Manjunatha N, Ganesh A, Mehrotra K, Bhaskarapillai B, Gunasekaran DM, Arora S, Sinha NK, Math SB. Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India. Psychiatr Q 2021; 92:1855-1866. [PMID: 34510379 DOI: 10.1007/s11126-021-09945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
Task-shifting is an important means to address the barrier of inadequate specialist human resources for mental health in countries such as India. This paper aims to report the impact of one such task-shifting initiative. Twenty-two non-specialist Medical Officers of Bihar, an eastern Indian state were engaged in a ten-month long hybrid (a 15-days onsite orientation to psychiatry and periodic online mentoring in primary care psychiatry) training program to enable them to identify commonly presenting psychiatric disorders in their respective clinics. 20 online sessions (hub and spoke ECHO model) occurred over the next 10 months. Apart from didactic topics, 75 cases covering severe mental disorders, common mental disorders and substance use disorders were discussed (case presentations by the primary care doctors (PCDs)) and moderated by a specialist psychiatrist and clinical psychologist). 12 successive self-reported monthly reports (comprising of the number and nature of psychiatric cases seen by the trainee PCDs) were analyzed. The mean (SD) number of sessions attended was 9 (8.0) and median was 13 (Range: 0-20). Mean number of cases (per PCD) discussed was 3.4 (3.4) (Median: 4; Range: 0-10). Total 20,909 patients were cared for in the 12 months after initiation of the training program. Increasingly, a greater number of patients were cared for as the training progressed. This pattern was mainly driven by more identifications of severe mental disorders (SMDs), common mental disorders (CMDs), dementias and substance use disorders. Mean (SD) number of patients seen per month before and after training was 1340.33 (86.73) and 1876.44 (236.51) (t = - 3.5, p < 0.05) respectively. A hybrid model of training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community. Prospective, well designed studies are essential to demonstrate the effectiveness of this model.
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Affiliation(s)
| | - Bhavya K Bairy
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - P Lakshmi Nirisha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopi V Gajera
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Aurobind Ganesh
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kanika Mehrotra
- Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjeev Arora
- Distinguished Professor of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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