Oral Paper Presentation

Dr. Ateev Chandna

 Assessing the Efficacy of a Three-Month
Digital Training Program for Primary Care
Physicians - Analysis of Diagnostic
Concordance, Socio-demographic Profiles,
and Clinical Characteristics in Collaborative
Title & Authors Video Consultations
 Ateev Sudhir Chandna1*, Hari Hara Suchandra1, Namrata
Bhardwaj1, Prerna Maheshwari1. Lakshmi Nirisha2, Suresh Bada
Math1, Narayana Manjunatha1 C Naveen Kumar1
1 – Department of Psychiatry, NIMHANS Bengaluru
2- Department of Psychiatry, AIIMS Raipur
* - presenting author
  Delivery of specialized healthcare in rural areas in India is lacking due
to the concentration of experts in urban areas.(C. Naveen Kumar et al
2019)
 High-speed internet accessibility has now enabled remote specialists
to connect with primary care physicians (PCDs) for clinical
consultations in rural areas - however only effective in short term
 Task shifting is a long-term approach to empower PCDs in treating
Introduction mental conditions within primary healthcare (PHC).(Hoef et al 2018)
 Using the ‘Clinical Schedules of Primary Care Psychiatry’ - NIMHANS
has been running online training programs using tele technologies to
train PCDs in screening, identifying, and treating psychiatric
disorders.(Kulkarni et. al 2019)
 These training programs have incorporated principles of adult
learning and top-down approach.
 The Training
The trainingProgram
programs
CHaMP Program
(Chhattisgarh Community
Mental Health Care
Telementoring program)

• This is a 3 month
certificate course for
PCDs

• The CHaMP Program was

initiated in August 2019
with the goal of providing
mental health training to
all primary care doctors
(PCDs) in Chhattisgarh,
India.
Collaborative Video Consultations (CVCs) - indirect measure of skill uptake & overall effectiveness of training
programs.(Jayasankar et al 2022)
 1. To analyze the effectiveness of the training program by
measuring diagnostic concordance between the tele
Aims & psychiatrist & PCD

Objectives 2. To analyze the socio-demographics and clinical profiles of

patients presenting to CVCs
  After each CVC, tele-psychiatrists had recorded all clinical
information, including diagnosis(based on CSP) in a specially
created proforma(CVC case sheet)
 A blinded researcher reviewed the records of all Collaborative
Video Consultations(From 2018-2022), with identifying data
masked to ensure blinding.
Methodology  The clinical data were analysed from CVC sheets meeting
inclusion criteria and exclusion criteria
 Inclusion Criteria - CVCs from November 2019 till August 2022,
Documented verbal consent from patients and PCDs
 Exclusion Criteria - CVC sheets with missing data, absence of a
documented verbal consent
CVC Data
Sheet
Results
 A total of 117 Socio-demographic ChaMP
CVC record characteristics

sheets from Gender (%) Male - 73 (63%)

Female - 44 (37%)
112 PCDs
were recorded Age (SD) 39.41 (13.876)

and analyzed
 Diagnosis
Treatment details
60%
52% 35% 32%
30% 28%
50%
25%
40% 20% 16%
15% 13%
29% 9%
30% 10%
5% 1%
20% 18% 0%
nt
s
t ics er
s
ne
s
nt
s
er
s
ss
a
ho li is ep
i e t h
10% re c ab az Ag O
p sy St i g
e it p od vin
1%
nt id An oo
d
nz ra
0% A M Be t ic
Neurotic Substance Use Psychotic Others An
Disorders Disorders Disorders
ChaMP Program (3 month)
ChaMP (3 months)
Diagnosis ChaMP Medication ChaMP
prescribed
n -165
n -117
Antidepressants 47
(28%)
Neurotic disorders 61
(Depression, Anxiety, Somatisation) (52.2%) Antipsychotics 22
(13%)
Substance Use Disorders 34 Mood Stabilisers 2
(29.1%) (1%)
Benzodiazepines 53
Psychotic Disorders 21 (32%)
(17.9%) Anticraving Agents 26
(16%)
Others 1
( Organic Disorders, IDD, Personality, ADHD) (0.9%) Others 15
(9%)
 ChaMP (3 Month Program)

 Concurrence of diagnosis – 94/117 (80.3%)

Diagnostic  Measure of Agreement (k) – 0.814 (Near perfect

Concordance agreement)
 ChaMP (3 months)

Duration between 19; 16%

Commencement of 28; 24%
Training and Conducting
the CVC- 8; 7%

11; 9%

51; 44%

less than 3 months 3-6 months 6-9 months

9-12 months > 12 months
 TrTrends of change in % concurrence over time Trends of change in
agreement (k) over
time
90.00% 83.50% 84.20% 0.9
0.838 0.84
80.00% 0.8

70.00% 0.7
0.645
63.20% 0.6
60.00%

0.5
50.00%
0.4
40.00%
0.3
30.00%
0.2
20.00%
ChaMP 0.1
10.00% ChaMP
0
0.00% less than 6 months 6-12 months >12 months
less than 6 months 6-12 months >12 months
 ChaMP (3 months) program
120%

100% 0.013 0 0
12.70%

Trends of
26.30%
31.60%
80%

Change in
30.40%

60% 15.80%
36.80%
Diagnosis 40%

over time 55.00% 52.60%

20% 36.80%

0%
<6 months 6-12 months > 12 months

neurotic substance psychotic other

  Our study demonstrated significant diagnostic concordance in the 3-month
program (80%), which aligns with a previous study that reported a concordance of
83% for a 1 year training program(DPCP) in Bihar.(Jayasankar et. al 2022)
 The ChaMP doctors demonstrated an initial very high level of performance near the
didactics period, followed by a sharp decline in diagnostic concordance after the 1
year mark. emphasising the need for refresher sessions beyond this period. (Leask 2020)
 In the later part of the training programs, there was a increase in CVCs for psychotic
diagnosis –
Discussion  This could indicate improved skills in identifying difficult disorders and increased
confidence in managing SUD, neurotic cases without need for expert opinion . These
findings are consistent with a literature review that analysed the impact of effective
training programs in improving knowledge, skill outcomes, and clinical practice
behaviours.(Bluestone et. al 2013)
 Overall, both the 3-month and 1-year programs were equally effective in
empowering PCDs to screen, diagnose, and treat a variety of mental illnesses’
based on the analysis of clinical data and concurrence of CVCs
 These findings are consistent with previous studies which have commented on the
significant impact of the ChaMP(Ibrahim et al 2022) and DPCP programs(Manjunatha. et al 2021)
on the community.
 Strengths Limitations

 First large scale study to

evaluate and compare the
effectiveness of 2 digital  Lack of information of socio-
Strengths & training programs
 This study shows the
demographic details of
doctors
Limitations feasibility of providing  Follow up data was not
instant video consultations to assessed
all PCDs, even in remote
districts
  The high concordance observed in our study indicates that these
programs are highly effective in task shifting to PCDs in the
community, opening the possibility for similar programs to be
planned and implemented in more locations.

Conclusion &  For maximum gains, training programs need to blend practical
and theory from early on in training and there should be provision
Future of regular booster sessions after a year of starting the program.

Directions  In the future, larger scale follow-up studies can be conducted to

gather more data and validate the findings of our study. These
studies can also incorporate qualitative assessments to
understand the experiences of doctors and identify any difficulties
they may face, ultimately leading to further improvements in the
training programs
 1. Jayasankar P, Nirisha PL, Manjunatha N, Kumar CN, Gajera GV, Malathesh BC, Pandey P, Suhas S, Ohri U, Kumar R,
Bajpai P, Kumar R, Math SB. Are the Collaborative Video Consultations module in Diploma in Primary Care Psychiatry
helpful. Indian J Psychiatry. 2022 Mar;64(Suppl 3):S516–20. doi: 10.4103/0019-5545.341490. Epub 2022 Mar 24. PMCID:
PMC9129560.
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psychiatry program on the integration of psychiatric care in the general practice of primary care doctors. Indian J
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Bairy, B. K., & Bada Math, S. (2022). Chhattisgarh community mental healthcare tele-mentoring program (CHaMP):
Digitally driven initiative to reach the unreached. The International journal of social psychiatry, 68(5), 954–957.
https://doi.org/10.1177/00207640211011191

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