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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 USACentre for Addiction Medicine, Dept. of Psychiatry, NIMHANS

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Goel et al. 2003SHORTAGE OF SKILLED MENTAL HEALTH PROFESSIONALS IN INDIA 3

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5NEED OF THE HOURNEW MODELS FOR MANPOWER DEVELOPMENT ANDDELIVERY OF QUALITY CARE SERVICES CAN TELEMENTORING BE A SOLUTION ?

AimsThe Medical Officer and Counsellor to be able to: 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.

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22nd Feb-7th March (ONSITE)

ONSITE TrainingCentre for Addiction Medicine

NIMHANSParticipation CertificateTraining 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 addictionMethods Blended Training 7

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

Didactic LecturesBedside clinical teachingEmergency case managementSupportive followed by independent case managementWorking in a multidisciplinary teamLearning best practices Training about public awareness disseminationSteps to initiate the deaddiction services in their district

Components

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Development of treatment protocol

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Phase II: Virtual Knowledge Network NIMHANS ECHOTele-mentoring, Handholding and E-Certificate ModuleMarch to September 12

Copyright Project ECHO 2015

ECHO (Extension for Community Health Outcomes) 13

Case discussion and Expert Didactic

Knowledge Network: NIMHANS Hub and District hospital Spokes Weekly LIVE Tele-Mentoring session (VIDEO)

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Easy to access anywhere: No cost to participantsSecured, encrypted, HIPAA compliant

Clinical Case PresentationMs Shalinipriya Dr SunilDr HaqueBrief case details should be informed to CAM, NIMHANS by email two days before presentation

Didactic LectureDepression: Identification and TreatmentDr. Prabhat Chand

Example of Tele-Health session 25th May 2016 2.30PM 15

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

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Resource Materials

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Results Flow of participants

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1814 Online Sessions over 6 monthsDidactics Opioid, cannabis and benzodiazepine use disordersMental status examination and cognitive functions Anxiety, depression and suicideCounselling skills and relapse prevention Anti-craving agents for alcohol and acute methanol poisoning

Results - Online component

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

Results - Online component

20Self 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 monthlyAssessing Outcomes of VKN NIMHANS BIHAR ECHO programme

VKN NIMHANS BIHAR ECHO CliniciansKnowledge Skills and Abilities in Management of Alcohol Use Disorders 24

22Outcomes of Treatment of Alcohol Use Disorders by VKN NIMHANS BIHAR ECHO Clinicians No deaths reported

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 costImportance of involvement of local leadership

Conclusions AND Lessons 26

24Future Challenges

25Dr. Prabhat Chand, Additional Professor, Department of Psychiatry, NIMHANS, BangaloreDoctors and Counselors of State Health Society, BiharFaculty of Centre for Addiction Medicine, Department of Psychiatry, NIMHANS, BangaloreAcknowlegements

26QUESTIONS AND CLARIFICATIONSE mail: jayantmahadevan@gmail.com