The “Primary care” means the provision of health care at first contact which will be nearer to the home of patients. Psychiatric illnesses are present in nearly 50% of patients attending primary care, but wrongly diagnosed leading to inadequate and incorrect treatments such as vitamin supplements, energy tonics, analgesics, intravenous fluids, etc. This leads to continued sufferings making them seek repeated consultations. An important reason for this scenario is that PCPs are not well equipped with skills essential for providing first line treatment to common psychiatric disorders.

In order to bridge this gap, Department of Psychiatry, NIMHANS has started a dedicated “Primary Care Psychiatry Program”. Its aim is skill development among doctors working at primary care focussing on screening, diagnosing and providing first line treatment/referral of psychiatric cases.

Training Activities of Primary Care Psychiatry Program

A. Class Room Training Program: This is traditional training program followed by psychiatrists to train PCPs in group format having audio-visual presentation. This is been organized at taluk hospitals, medical colleges, etc with in collaboration with Indian Medical Association, and /or District/Taluk Hospital Officers concerned. Team conducted this programs at Anekal taluk hospital, Mandya Institute of Medical Sciences- Mandya. Plan is conduct this one day programs at all districts of Karnataka in collaboration with local medical colleges.

B. On-Consultation Training (OCT) Programs: As name itself denotes, training is being conducted while their live, real time consultations of primary care physicians.

Two variants of this OCT programs are designed and developed.

In-person OCT” (I-OCT): A psychiatrist sits along with two PCPs (one is active, another is passive) at their clinic and sees their live real time consultations. Patients (for this OCT) are chosen from the PCP’s general pool of patients. The psychiatrist then helps them to screen and identify common psychiatric disorders. Additionally, the psychiatrist demonstrates them how to ask right kind of questions that elicit symptoms, and assists them to provide first line treatment.

Tele-OCT: (Tele-psychiatric OCT). It is essentially similar to I-OCT except psychiatrist participate in videoconference mode.

Currently, Tele-OCT is under pilot at Mandya district in collaboration with Government of Karnataka. Doctors who have undergone these sessions have expressed high level of satisfaction and are confident of translating these learnt skills into their practice. The “Clinical Schedules for Primary Care Psychiatry” (CSP) is designed to make OCT more structured and more efficient. This CSP is already an integral part of OCT. CSP is available on request.

Future directions

(a) Validation of CSP,

(b) Outcome assessment of OCT

(c) Extended On-Consultation Training (E-OCT) clinic: Aim is to extend clinical support for doctors who have undergone about 3 OCT sessions and

(d) Periodic Online CME (Continuing Medical Education) will consists of case conference, seminar, journal club format.

The members of the Primary care Psychiatry team of NIMHANS, Bengaluru

Dr. Suresh Bada Math, Professor of Psychiatry and Head of Telemedicine
Dr. C Naveen Kumar, Additional Professor of Psychiatry
Dr. N Manjunatha, Associate Professor of Psychiatry .
Dr. Shashidhara HN, Specialist Grade Psychiatrist
Dr. Vinay B, Specialist Grade Psychiatrist
Dr Santhosh Kumar – Senior Resident – PCPP program
Dr Guru S Gowda, Senior Resident of Psychiatry
Dr Malathesh BC, Senior Resident of Psychiatry
Dr Karishma kulkarni, Senior Resident of Psychiatry
Mr Manjunatha BR, Telemedicine Technician.
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Additional Information

September 12, 2019
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NIMHANS, Bengaluru
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