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Tobacco Cessation Training for remote counsellors through “Hybrid Learning”


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A pilot from the NIMHANS in collaboration with Anti-Tobacco Cell NHM, GoK

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Tobacco Cessation Training for remote counsellors through “Hybrid Learning”

  1. 1. A pilot from the NIMHANS in collaboration with Anti- Tobacco Cell NHM, GoK
  2. 2. DEMOCRATIZING KNOWLEDGE and Amplify the Capacity to provide Best Practice Care in Addiction and Mental Health in Districts by Leveraging Technology Virtual Knowledge Network NIMHANS ECHO (Extension of Community Healthcare Outcome) MOVE KNOWLEDGE : NOT PATIENTS
  3. 3.  Sharing “best practices” to reduce disparities  “Case based learning” & “Wisdom” to master complexities  Using “Technology” to leverage scarce resources  Immersive, Deep & Continued Learning  “Web based” database to monitor outcomes
  4. 4. VKN NIMHANS Physicians/Health Provider Geographical Distance and Cost should not be a barrier for specialist care in this era
  5. 5. NIMHANS HUB (Multi-disciplinary team) 5 Psychiatry social work Psychiatrist: Addiction Psychologist Psychiatrist & Clinical Case Expert Psychiatrist & Addiction Expert IT support CO-ordinator Didactic Presenter Clinic Facilitator
  6. 6. Easy to access anywhere: No cost to participants Weekly Case discussion and Expert Didactic topic
  7. 7.  29% of adults use Tobacco  Poor Quit attempt  <50% advised to quit tobacco by health professionals  <10% provided any help to Quit Helping People Quit Tobacco: A manual for Doctors and Dentists by Murthy, Murali and Hiremath: WHO SEARO 2010 Smoking (%) Smokeless (%) Male 24 33 Female 3 18 • >75% (WHO) shortage of skilled health Professionals • Especially rural and underserved population • Significant “disparities” in treatment VERSUS
  8. 8. Step 2: Onsite Sensitization (6 hr) Step 3: Hybrid learning Mobile based Multipoint tele-ECHO clinics every fortnightly for 2hrs & e-learning Periodic Outcome Assessments
  9. 9. The remote district counsellors will be able • Identification, Screening for Tobacco Dependence and contributing factors influencing it • Handling brief psychosocial interventions • Decision making about what can be managed by the District Counselors and what needs to be referred to a higher centers having expertise in tobacco cessation treatment
  10. 10. No. of counsellors participated No. of districts No. of Counsellors joined for at least one virtual tele-ECHO clinic out of six No. of Counsellors joined for minimum 6 or more virtual tele-ECHO clinics (>50%) out of twelve No. of Counsellors joined for minimum 8 or more virtual tele-ECHO clinics (>80%) out of twelve No. of Counsellors presented patient cases 27(100%) 16 27 22 (81.48%) 14 (51.85%) 22 (81.48%) Those who has joined 3 sessions more likely to join for future sessions, 90% join through Smartphone Engagement of Remote Community Counselors with NIMHANS
  11. 11. March April May June July August septem ber No.of Patients 401 536 574 754 738 758 769 0 100 200 300 400 500 600 700 800 900 Remote Community Patients Co-managed with input from NIMHANS Experts N=60 4000 + Patients received “best practices” care at their own place, known people/counsellor, no Travel in a public health system only Nicotine addiction 47% Nicotine with Medical Health Issues 17% Nicotine with other substances 23% Nicotine with Psychiatric co morbidities 4% Nicotine + other substances +Medical Issues 9% Direct patient benefit: 60 Double the number of patients having tobacco addiction
  12. 12. 0 5 10 15 20 25 30 35 40 45 50 No change Reduced use Stopped use Lost follow up Relapse Pre training post training Status of Patients Tobacco Use Pre & Post Training No change Reduced use Stopped use Lost follow up Relapse Pre training 12.91 45.96 11.98 10.27 19.07 post training 5.87 46.6 27.89 6.97 12.66 Double the number of patients STOPPED using tobacco
  13. 13. Total No. of e-learning assignments No. of counsellors completed all assignments in specified duration (2 weeks) No. of counsellors not able to complete No. of counsellors not attempt at all No. of counsellors required >5 attempts to complete No. of mobile reminder calls/texts/whatsapp to counsellors, to make increasing motivation to complete E- learning per assignment 06 20(74.07%) 03(11.11%) 04(14.81%) 07(25.92%) 25-30
  14. 14.  This method of training is feasible, cost effective and the benefit is translating to increased number of patients seeking help for Tobacco Cessation.  Integration of Mental Health as well as NCD will be more beneficial and impactful. As there is >30% cases having substance use/ Mental Health issues / NCD. So the District Mental Health /NCD/Tobacco counselors can work together with mentoring by NIMHANS Hub.  Dentists working in the districts can also play an important role in the Tobacco Cessation. Return of Investment (RoI) in NIMHANS ECHO Anticipated Cost for the State Patient cost Cost for patient1000 per visit*4 times*4000 = 16000000 Counselor cost of training: 2000*27*12: 648000 TOTAL cost would have :16648000 INR Actual Cost: 50000 * • The time of experts not added
  15. 15. Virtual Knowledge Network NIMHANS Linking Academic Multidisciplinary Specialists to Community health professionals INNOVATIVE VIRTUAL-MENTORING MODEL FOR SKILLED CAPACITY AND QUALITY CARE in ADDICTION & MENTAL HEALTH Join the Movement Vknnimhans @virtual_NIMHANS