Kumar Channaveerachari Naveen, Chand Prabhat Kumar, Manjunatha Narayana, Math Suresh Bada, Shashidhara Harihara Nagabhushana, Basavaraju Vinay, Thirthalli Jagadisha, Manjappa Adarsha Alur, Parthasarathy Rajani, Murthy Pratima, Ibrahim Ferose Azeez, Jagtap Namrata, Jyrwa Sonakshi, Reddy Shanivaram, Arora Sanjeev, Hawk Mary, Kumar Supriya, Egan James, Mcdonald Margaret
Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Dept. of Health and Family Welfare Service, Government of Karnataka, Bengaluru, Karnataka, India.
Indian J Psychol Med. 2020 Dec;42(6 Suppl):S80-S86. doi: 10.1177/0253717620969066. Epub 2020 Dec 7.
Bridging the alarming treatment gap for mental disorders in India requires a monumental effort from all stakeholders. Harnessing digital technology is one of the potential ways to leapfrog many known barriers for capacity building.
The ongoing Virtual Knowledge Network (VKN)-National Institute of Mental Health and Neurosciences (NIMHANS)-Extension of Community Health Outcomes (ECHO) (VKN-NIMHANS-ECHO: hub and spokes model) model for skilled capacity building is a collaborative effort between NIMHANS and the University of New Mexico Health Sciences Centre, USA. This article aims to summarize the methodology of two randomized controlled trials funded by the Indian Council of Medical Research (ICMR) designed to evaluate the effectiveness of the VKN-NIMHANS-ECHO model of training as compared to training as usual (TAU).
Both RCTs were conducted in Karnataka, a southern Indian state in which the DMHP operates in all districts. We compared the impact of the following two models of capacity building for the DMHP workforce (a) the VKN-NIMHANS-ECHO model and (b) the traditional method. We use the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement to describe the methods of these two trials.Trial 1 is to evaluate the "Effectiveness of addition of Virtual-NIMHANS-ECHO tele-mentoring model for skilled capacity building in providing quality care in alcohol use disorders by the existing staff of DMHP districts of Karnataka." Hub for trial 1 was set up at NIMHANS and the spokes were psychiatrists and other mental health professionals headquartered in the district level office. Trial 2 assesses the implementation and evaluation of the NIMHANS-ECHO blended training program for the DMHP workforce in a rural south-Indian district of Karnataka state. The hub for trial 2 was set up in the district headquarter of Ramanagaram. Hub specialists are DMHP psychiatrists, whereas spokes are the non-doctor workforce (including auxiliary nurse midwives [ANMs] and accredited social health activists [ASHA] workers) medical officers of primary health centers. The location of the HubHub differs in these two studies. Both trials are funded by the ICMR, Government of India.
Both these trials, though conceptually similar, have some operational differences which have been highlighted. If demonstrated to be effective, this model of telementoring can be generalized and widely merged into the Indian health care system, thus aiding in reducing the treatment gap for patients unable to access care.
缩小印度精神障碍治疗差距巨大的这一令人担忧的局面，需要所有利益相关者付出巨大努力。利用数字技术是跨越能力建设诸多已知障碍的潜在途径之一。
正在进行的虚拟知识网络（VKN）-国家精神卫生和神经科学研究所（NIMHANS）-社区健康成果扩展（ECHO）（VKN-NIMHANS-ECHO：中心与分支模式）技能能力建设模式是NIMHANS与美国新墨西哥大学健康科学中心的合作成果。本文旨在总结由印度医学研究理事会（ICMR）资助的两项随机对照试验的方法，这些试验旨在评估VKN-NIMHANS-ECHO培训模式与常规培训（TAU）相比的有效性。
两项随机对照试验均在印度南部卡纳塔克邦进行，该邦的地区精神卫生项目（DMHP）在所有地区开展。我们比较了以下两种针对DMHP工作人员的能力建设模式的影响：（a）VKN-NIMHANS-ECHO模式和（b）传统方法。我们使用SPIRIT（标准方案项目：干预试验建议）声明来描述这两项试验的方法。试验1旨在评估“为卡纳塔克邦DMHP地区现有工作人员在酒精使用障碍优质护理中增加虚拟-NIMHANS-ECHO远程指导模式进行技能能力建设的有效性”。试验1的中心设在NIMHANS，分支是总部位于地区级办公室的精神科医生和其他心理健康专业人员。试验2评估在卡纳塔克邦一个印度南部农村地区为DMHP工作人员开展的NIMHANS-ECHO混合培训项目的实施和评估情况。试验2的中心设在拉马纳加姆地区总部。中心专家是DMHP精神科医生，而分支是初级卫生中心的非医生工作人员（包括助产士[ANMs]和经认可的社会健康活动家[ASHA]工作人员）及医务人员。这两项研究中中心的位置不同。两项试验均由印度政府ICMR资助。
这两项试验虽然在概念上相似，但存在一些已突出显示的操作差异。如果证明有效，这种远程指导模式可以推广并广泛融入印度医疗保健系统，从而有助于缩小无法获得护理的患者的治疗差距。
