PRIMARY CARE PSYCHIATRY PROGRAM
About the Program
The Primary Care Psychiatry Program (PCPP) is an initiative from the Tele Medicine Centre, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India which has now evolved into a diploma course as ‘Diploma in Primary Care Psychiatry (DPCP)’ as a prototype course. Training modules for primary care psychiatry.
Evolution – Mandya pilot project
The pilot for training PCDs began in Mandya District of Karnataka State from August 2016 to August 2018. Clinical Schedule for Primary care Psychiatry (CSP) was used as the curriculum and digital modules included Tele-OCT and CVC. It also included 3 days of classical onsite training for 133 Primary Care Doctors. Out of them, 71 participants completed their online training. Each doctor got four OCT sessions with a gap of 1 month each. A total 113 Tele-OCT sessions were successfully conducted. A total of 823 patients were seen during this training period.
DIPLOMA IN PRIMARY CARE PSYCHIATRY
Out of the pilot experience in Mandya evolved the Diploma in Primary Care Psychiatry (DPCP) course which is a 1 year digitally driven online module in addition to a 10 day onsite course at NIMHANS. The details of the DPCP course are as follows: Classical onsite module Onsite training is nothing but the classical classroom teaching, where a general orientation towards psychiatric disorders is imparted. Additionally, participants are also given an outline of the entire programme, various digital modules and in-person observation of psychiatry consultations. Typically, it forms a minor part of the whole program.
Tele- on consultation training (Tele-OCT): It based on the hub (tele-psychiatrists at NIMHANS) – and – spoke (Primary Care Doctor; PCD) model. OCT is an on-job/hand-holding training conducted in live, real-time clinical scenarios while PCDs are providing consultations to their general patients. The goal of OCT is to maximize the quality of the general practice of PCDs with the provision of providing standard psychiatric care to patients with psychiatric disorders. It incorporates the principles of ‘real patients, real consultations, but with new clinical practice acumen’. It causes minimal disruption to their clinical work. It incorporates principles of adult learning, a bottom–up approach wherein each and every clinical skill is taken care separately from entry-to-exit of patients. The curriculum used in training is CSP. Typically, there are one-to-one sessions and each session lasts for about 2–3hrs, wherein 10–15 consecutive patients are seen. In the first session, tele-psychiatrists will demonstrate interviewing skills and teach different guidelines from CSP. During the second session, PCDs will be asked to see the patients of his/her outpatient department and screen them for psychiatric illness using the screener provided in CSP; while this is ongoing, the tele-psychiatrist will be observing the PCD and will guide him/her in using the diagnostic guidelines and management guidelines. Typically, in the second session the tele-psychiatrist will take the lead in assessing and diagnosing the patient. During the third and fourth sessions, PCDs will take the lead and the psychiatrist will observe and intervene only if necessary. Typically, the frequency of the sessions are at 1st week, 3rd week, and 7th week after the initial training. The Tele-OCT has dual outcomes: one is training PCDs and the other is providing consultation from collaborative care.
Virtual classroom (VCR): It is based on the hub (tele psychiatrists at NIMHANS)-and-spoke (PCD) model and the principle of peer learning. It includes interactive sessions in the form of seminars, case discussions, and expert lectures. The seminar on selected topics will be presented by the trainee to their fellow participants in the presence of a tele-psychiatrist. Typically, such a session would be conducted weekly and the total duration of the session would be around 1hr.
Collaborative video consultation (CVC): this module is based on the practice-based learning using one-to-one consultation with the patient and PCD. Live and real-time video-based assistance will be provided by a tele psychiatrist on all working days for discussion of selected cases by PCDs. PCDs chose cases for discussion depending upon the difficulty level of the case, and in collaboration with tele-psychiatrists they decide the best management plan for selected patients. The tele-psychiatrist uses the case-based learning approach and video demonstration to help PCD gain the skill of interviewing the psychiatric patient. Typically, such a session would last for 15–20 min.
Virtual case conference (VCC): It is based on the hub (tele psychiatrists at NIMHANS)-and-spoke (PCD) model and the principle of peer learning. It includes interactive sessions in the form of virtual live case discussion, on prefixed date and time, with tele-psychiatrists while the fellow PCDs are connected through different spokes and observe the case discussion and live patient interview to obtain clinical skills.
DPCP BASED PROGRAMS
Karnataka Telemedicine Mentoring and Monitoring Program (KTM)
District Mental Health Program – Uttarakhand
Primary Care Psychiatry Program for Bihar
CHaMP – Chhattisgarh Community Mental Healthcare Tele-Mentoring Program
PRIMARY CARE PSYCHIATRY PROJECTS
TORENT – Tele-mentoring For Rural Health Organisers Of Chhattisgarh