The document discusses a pilot program called the Virtual Knowledge Network NIMHANS ECHO that aims to leverage technology to provide specialist mental health and addiction care in rural districts. It does this through weekly virtual case discussions and expert lectures connecting a multi-disciplinary team at NIMHANS to remote district counselors. Early results found the program doubled the number of patients who stopped using tobacco and increased access to best practices for over 4,000 patients at a lower cost than traveling to specialist centers.

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

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.  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. VKN NIMHANS
Physicians/Health
Provider
Geographical Distance and Cost should not be a barrier for specialist care in
this era

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. Easy to access anywhere:
No cost to participants
Weekly Case discussion and Expert Didactic topic

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

9. 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

10. 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

13. 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

14. 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

15. 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

16. 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

17.  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

18. 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
vlc.nimhans.ac.in
Vknnimhans @virtual_NIMHANS
vkn.nimhans@gmail.com