Banerjee Debanjan, Vajawat Bhavika, Varshney Prateek, Rao Ts Sathyanarayana
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, India.
Front Psychiatry. 2021 Jan 20;11:615758. doi: 10.3389/fpsyt.2020.615758. eCollection 2020.
With 5.3 million people living with dementia in India and the pandemic wreaking havoc, dementia care has faced unique challenges during the outbreak, with reduced healthcare access, travel restriction, long-term lockdown and fear of hospitalization. We explored the experiences and barriers faced by the physicians involved in dementia care during the lockdown period. A qualitative approach was used with purposive sampling. After an initial pilot, 148 physicians were included in the study. They were virtually interviewed in-depth based on a pre-designed semi-structured questionnaire, in areas related to tele-consultations, attributes related to dementia care, challenges faced and way forward. Interviews were recorded, transcribed and thematically analyzed using Nvivo-10 software. Triangulation, peer debriefing and respondent validation were used to ensure rigor. The overarching categories that emerged were "Tele-medicine as the future of dementia care in India," "people living with dementia being uniquely susceptible to the pandemic with a triple burden of: " and "markedly reduced healthcare access in this population with significant mental health burden of caregivers." The experiences of the physicians were categorized into their challenges during the lockdown period and perceptions related to specific facets of dementia care during the crisis. The general physicians expressed special "unmet needs" of dementia-specific training and specialist collaboration. Most of the participants perceived ambiguity related to the newly released telepsychiatry guidelines. Resource constraints and pandemic burden are currently high. This study looks at the "voices" of those actively providing dementia care during the ongoing crisis and to the best of our knowledge, is the first one from India to do so. Concurring with their experiences, PwD and their families are exposed to multiple vulnerabilities during COVID-19, need tailored care, especially at the primary healthcare level which includes general physicians. These relevant "voices" are discussed in light of the new tele-psychiatry guidelines and further optimization of dementia care in an aging India.
印度有530万人患有痴呆症，而新冠疫情肆虐，在疫情爆发期间，痴呆症护理面临着独特的挑战，包括医疗服务可及性降低、出行限制、长期封锁以及对住院治疗的恐惧。我们探讨了在封锁期间参与痴呆症护理的医生所面临的经历和障碍。采用了定性研究方法并进行了目的抽样。经过初步试点后，148名医生被纳入研究。根据预先设计的半结构化问卷，在与远程会诊、痴呆症护理相关属性、面临的挑战及未来方向等领域，对他们进行了深入的虚拟访谈。访谈进行了录音、转录，并使用Nvivo - 10软件进行了主题分析。采用三角互证、同行汇报和受访者验证来确保研究的严谨性。出现的总体类别包括“远程医疗作为印度痴呆症护理的未来”、“痴呆症患者特别容易受到疫情影响，承受三重负担”以及“该人群的医疗服务可及性显著降低，护理人员承受巨大心理健康负担”。医生的经历被分为他们在封锁期间面临的挑战以及对危机期间痴呆症护理特定方面的看法。普通医生表达了对痴呆症专项培训和专家合作的特殊“未满足需求”。大多数参与者认为新发布的远程精神病学指南存在模糊之处。目前资源限制和疫情负担都很重。本研究关注在当前危机中积极提供痴呆症护理的人员的“声音”，据我们所知，这是印度首个此类研究。与他们的经历一致，痴呆症患者及其家人在新冠疫情期间面临多种脆弱性，需要量身定制的护理，尤其是在包括普通医生在内的初级医疗保健层面。将根据新的远程精神病学指南以及在老龄化的印度进一步优化痴呆症护理来讨论这些相关“声音”。
