Innovative telementoring for addiction management for remote primary care physicians: A feasibility study

Addiction is a growing public health problem which affects the person, the whole family, and society. The primary care physician (PCP) is often the first point of contact in the health care and can play a significant role in the early detection and intervention. It is well established that early intervention is associated with better outcomes. In the formal medical training, PCPs receive no formal training on drug addiction management. In this pilot study, we developed an innovative telementoring model and looked at feasibility as well as acceptability among remote PCPs on drug addiction management.

The telementoring model consists of both synchronous and asynchronous components. The synchronous component consists of National Institute of Mental Health And Neuro Sciences (NIMHANS) academic center Hub and remote district level primary care physician Spokes, and is implemented by using low-cost multipoint videoconference based tele-ECHO (Extension for Community Healthcare Outcome) 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 telementoring program on participant engagement, learning, confidence, and satisfaction. A pre-post design and e-learning assignments were used to measure the outcomes.

Of the proposed 21 tele-ECHO clinics, 11 were held till the end of August 2017. All the PCPs were able to virtually join at least one 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. About 76.31% (n = 29) of the PCPs presented 41 patient case summaries. Among 38 PCPs, a cumulative of 89.47% completed three e-Learning assignments. The majority of participants (80%) used smartphone with 4G connections to join the tele-ECHO clinics. There was a significant change in knowledge gained over the time duration of 1-month (3.00 ± 0.86, P < 0.001) and 3-month (3.16 ± 0.90, P < 0.001) assessments compared to the baseline (1.77 ± 1.02). About 32.25% (n = 10) reported improved confidence level in managing a case of substance use disorder on a 10-point scale.

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 high rate of e-learning assignment completion. These findings suggest that this new innovative learning model using technology can be an important modality for effective training to address management of drug addiction.