Evaluating feasibility of Virtual Mentoring connecting an academic centre by Jayant Mahadevan, NIMHANS, India

1. EVALUATING THE FEASIBILITY OF VIRTUAL
MENTORING CONNECTING AN ACADEMIC
CENTRE TO DISTRICT HEALTH PROFESSIONALS
FROM BIHAR IN PROVIDING QUALITY CARE FOR
ALCOHOL USE DISORDERS
Jayant M, Lekhansh S, Ashfaq A, Sunil K*, Narendra Sinha*,A K Shahi*, Prabhat
C, Arun K, Lakshmanan S, Pratima Murthy, Vivek Benegal, Miriam Komaromy#,
Sanjeev Arora#
*State Health Society Bihar
# ECHO Institute USA
Centre for Addiction Medicine, Dept. of Psychiatry, NIMHANS
1

2. Goel et al. 2003
0
5000
10000
15000
20000
25000
Psychiatrists Psychologists Psychiatric
Social
Workers
Psychiatric
Nurses
Current
Required
SHORTAGE OF SKILLED MENTAL
HEALTH PROFESSIONALS IN INDIA
3

3. 2

4. 5

5. 5
NEED OF THE HOUR
NEW MODELS
FOR
MANPOWER DEVELOPMENT
AND
DELIVERY OF QUALITY CARE SERVICES
CAN TELEMENTORING BE A
SOLUTION ?

6. Aims
The Medical Officer and Counsellor to be able to:
1. Identify and intervene to address alcohol use
disorder and addiction in the district hospitals.
2. Fortnightly discuss the clinical cases and expert
didactics with NIMHANS multi-disciplinary team
from their work place through VKN NIMHANS
ECHO.
6

7. 22nd Feb-7th March (ONSITE)
ONSITE Training
Centre for Addiction
Medicine
NIMHANS
Participation
Certificate
Training certificate
part 1
Virtual Knowledge Network (ONLINE LIVE)
(March to September fortnightly)
Live Online
Handholding
2nd and 4th Wednesdays
2.30 PM-4PM)
Training
Certificate
FINAL
CERTIFICATE*
*Based on regular participation (>75%), 4 (minimum) Case Presentation & Case
Discussion required to entry into the FINAL ONLINE assessment for a trained
e-certificate in Alcohol addiction
Methods – Blended Training
7

8. Phase I: ONSITE 22nd Feb to 7th
March
8

9.  Didactic Lectures
 Bedside clinical teaching
 Emergency case
management
 Supportive followed by
independent case
management
 Working in a
multidisciplinary team
 Learning best practices
 Training about public
awareness dissemination
 Steps to initiate the
deaddiction services in their
district
Components
9

10. Development of treatment protocol
10

11. Phase II: Virtual Knowledge
Network NIMHANS ECHO
Tele-mentoring, Handholding and
E-Certificate Module
March to September
12

12. Copyright Project
ECHO 2015
ECHO (Extension for Community
Health Outcomes)
13

13. Case discussion and
Expert Didactic
Knowledge Network: NIMHANS Hub and
District hospital Spokes
Weekly LIVE Tele-Mentoring session (VIDEO)
14
Easy to access anywhere: No cost to
participants
Secured, encrypted,
HIPAA compliant

14. Clinical Case Presentation
1. Ms Shalinipriya
2. Dr Sunil
3. Dr Haque
Brief case details should
be informed to CAM,
NIMHANS by email two
days before presentation
Didactic Lecture
Depression:
Identification and
Treatment
Dr. Prabhat Chand
Example of Tele-Health session
25th May 2016
2.30PM
15

15. Micro-website
Standard practice & Treatment Guideline, Videos and
powerpoints (http://bit.ly/nimhans_bihar_echo)16

16. Resource Materials
17

17. 27
• Number of trainees who
attended the onsite component –
Phase 1
20
• Number of trainees who
attended the online component –
Phase 2
8
• Number of trainees who gave the
exit exam and received training
completion certificate
Results – Flow of participants
18

18. 18
• 14 Online Sessions over 6 months
• Didactics –
– Opioid, cannabis and benzodiazepine use disorders
– Mental status examination and cognitive functions
– Anxiety, depression and suicide
– Counselling skills and relapse prevention
– Anti-craving agents for alcohol and acute methanol
poisoning
Results - Online component

19. 19
• Instances of participation = 137
• Cases discussed = 50
As per the subjective report of trainees
• Online component contributed 72% of the
TOTAL LEARNING gained from the BLENDED
TRAINING
Results - Online component

20. 20
• Self rated questionnaire – At Baseline, 3
months and 6 months (Assess knowledge,
skills and self efficacy)
• Clinical reporting forms – Number of patients
seen, interventions provided and outcomes
daily and monthly
Assessing Outcomes of VKN NIMHANS
BIHAR ECHO programme

21. VKN NIMHANS BIHAR ECHO Clinicians
Knowledge Skills and Abilities in
Management of Alcohol Use Disorders
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Details of
alcohol use
Discuss risks
of alcohol
Identifying
triggers and
managing
craving
Prescribing
appropriate
medications
BEFORE TRAINING
AFTER TRAINING
24

22. 22
Outcomes of Treatment of Alcohol Use Disorders
by VKN NIMHANS BIHAR ECHO Clinicians
Cases
screened 2695
Inpatients
536 (19.8%)
Referred to
higher centers
80 (14.9 %)
Severe alcohol
use problems
832 (30.8%)
Follow up 1336
(49.1%)
Other
substances 581
(21.5%)
No deaths
reported

23. • Blended training with virtual mentoring of non
specialist physicians and counselors is feasible,
acceptable and translates to a good standard
of patient care
• Relatively low cost
• Importance of involvement of local leadership
Conclusions AND Lessons
26

24. 24
Clinical
• Emergence
of other
substance
use
Technological
• High speed
internet
connectivity
• Cost
Pedagogical
• Sustaining
interest of
health care
providers
Future Challenges

25. 25
• Dr. Prabhat Chand, Additional Professor,
Department of Psychiatry, NIMHANS,
Bangalore
• Doctors and Counselors of State Health
Society, Bihar
• Faculty of Centre for Addiction Medicine,
Department of Psychiatry, NIMHANS,
Bangalore
Acknowlegements

26. 26
QUESTIONS AND
CLARIFICATIONS
E – mail: jayantmahadevan@gmail.com