Innovative Tele-mentoring in Addiction Management for Remote Primary Care Physicians: A Feasibility Study

Abstract

Objective: Addiction or Substance Use Disorder (SUD) is a growing public health problem which affects the person, the whole family and society. The primary care physician is often the first point of contact in health care and can play a significant role in early detection and intervention. It is well established that early intervention is associated with better outcome, however in their formal medical training; primary care physicians receive no formal training on drug addiction management. In this pilot study we developed an innovative tele-mentoring model for drug addiction management and looked at feasibility as well acceptability among remote primary care physicians (PCPs). Methods:The tele-mentoring model consists of both synchronous and asynchronous components. The synchronous component (which includes the National Institute of Mental Health And Neuro Sciences (NIMHANS) academic centre Hub and remote district level primary care Spoke), is implemented by use of low-cost multipoint videoconference based tele-ECHO clinics. During the tele-ECHO clinics, held fortnightly, the remote PCPs used internet enabled smartphones to connect as well as present the patient case summaries to the multidisciplinary expert team of NIMHANS HUB. The asynchronous component consists of mobile based ubiquitous e-learning integrated to a course completion certificate. We evaluated this innovative tele-mentoring Programme on participant engagement, learning, competence and satisfaction. A pre-post design and e-learning assignments were used to measure the outcomes. Results: Of the proposed 21 tele-ECHO clinics, 11 were held till the end of August 2017. All the primary care physicians were able to virtually join at least one drug tele-ECHO clinic. Out of 38 participants, two participated in all the tele-ECHO clinics and 47.36% (n=18) attended more than six (>60% of total) tele-ECHO clinics. 76.31% (n=29) of the PCPs presented 41 patient case summaries. Among 38 PCPs, a cumulative of 89.47% has completed three E-Learning assignments. Majority of participants (80%) used smartphone with 4G connections to join the tele-ECHO clinics. There was a significant increase in the score on knowledge gained over the time duration of 1 month (3.00±0.86, p < 0.001) and 3 months (3.16±0.90, p < 0.001) assessments compared to the baseline (1.77±1.02). 32.25% (n=10) reported improved confidence level in managing a case of SUD on 10 point scale. Discussion: It has been feasible to connect an academic hub i.e. NIMHANS to the PCPs of 36 remote districts of Bihar and conduct multipoint videoconference based tele-ECHO clinics. The results indicate high-participant retention. The learners are comfortable in adapting new technology based learning as evidenced by higher rate of e-learning assignment completion. These findings suggest this new innovative learning model using technology can be an important way for effective training to address addiction management.

Capacity Building in Mental Health for Bihar: Overview of the 1-Year Blended Training Program for Nonspecialist Medical Officers

“…It is in this context, the initiatives of the National Institute of Mental Health and Neurosciences (NIMHANS), a tertiary care neuropsychiatric academic institute situated in Bengaluru, India are pioneering. 9,10 Virtual Knowledge Network (VKN)-ECHO is one such collaboration of NIMHANS with Project ECHO of the University of New Mexico (UNM). Project ECHO (Extension for Community Healthcare Outcomes) is designed to provide best practice care to rural and remote communities that are otherwise underserved.…”