An Initiative by IAPC

Supported by Hyderabad Centre for Palliative Care & Two Worlds Cancer Collaboration

Topic: Redesigning existing Palliative Care Services in COVID Time.

By offering the services through “virtual care” which includes tele- consultation, video calls, online prescriptions, and finding alternate ways to provide medicines and other essentials, Palliative Care Providers in India are adapting various methods to meet the needs of those who are under their care amidst the restrictions due to lock down, as well as to overcome the threat of COVID-19 infection. Strategies to provide “Virtual Care” efficiently were shared in the second session of echo series organized by Indian Association of Palliative Care with the support of Hyderabad Centre for Palliative Care and Two Worlds Cancer Collaboration, Canada, held on 9th April, 2020, from 6:30 am to 7:30 am.

Dr. Tushar Shah, a physician, based at Mumbai, who is the founder of the popular Tele- consultation platform and Dr. Lulu Mathews, Program Director, Academics, Institute of Palliative Medicine (IPM), Kozhikode shared their experiences and explained how virtual care can be provided effectively.

According to Dr. Tushar Shah, Symptom assessment can be done efficiently in virtual care and for this systematic approach is essential. “Taking history of the patient is very important in tele-consultation. Ask the patient to send text/voice messages with details of symptoms, before starting discussion. Only after assessing this message, talk to the patient. During tele-consultation, allow the patient to talk for the initial 20 seconds without interruption.” – Dr. Shah explained the important rules to be followed during tele-consultation.

As of his experience, this method helps to collect as many information as possible. “After 20 seconds, the patient starts rambling. At this point intervene and ask relevant questions” – explained Dr. Tushar Shah. ‘Talk directly to patients, not to relatives’ – is the rule that Dr Tushar Shah follows in Tele-consultation. He finds that the description about disease conditions given by a carer is entirely different from that given by the patient. He uses video calls or get picture of affected part of the body only when he finds it as helpful in diagnosing the condition. “During a video conference, if the patient can see the doctor, it will give the patient an extreme sense of satisfaction” – Dr. Tushar Shah points out while answering a question. “Patient consent is essential for tele-consultation if it is initiated by the care provider” – he said.

Dr. Lulu Mathews, Program Director, Academics, Institute of Palliative Medicine (IPM), Kozhikode, explained the swift changes her Institute made to assure care to the patients during the lock down period. Even though they had to shut down their inpatient services due to restrictions, IPM is maintaining patient care mainly through tele-consultation and maintains a 24X7 help line to support patients. One nurse in each shift has been deputed exclusively for managing phone calls of patients and thus provides 24 hour telephone helpline. Patients scheduled to visit OP for review and scheduled to visit by home care team are contacted by a senior nurse over phone to review their condition. If any medical intervention is needed, the call will be handed over to the doctor. If patient needs urgent attention, the home care unit, with a nurse and driver, visits the patient. Doctor is available on call for discussion. If there is any change in medication is needed, prescription is forwarded to the patient as text messages by the doctor.

“In this virtual process, documentation is very important. The nurse handling the telephone call is given strict instruction to document each and every step” – said Dr. Lulu Mathews. According to MCI guidelines all call log and data used for tele-medicine interaction should be retained by the care provider.

Ms. Camara Van Breeman explained strategies to be followed in virtual care and Dr.Megan Doherty shared templates that can be used for virtual consultation.

“In the current situation, no system can be ideal. We have to make care plan for long period, some times for 2-3 months” – Dr. Sushma Bhatnagar, President, IAPC expressed her opinion.

Dr. Spandana Rayala of HCPC explained the MCI guidelines for tele-consultation. A registered medical practitioner providing consultation via tele-medicine cannot prescribe medicines listed in Schedule X of Drug and Cosmetic Act. Narcotic drugs come under this category.

Next Session in this ECHO Series will be held on 16th April, 2020 (Thursday) from 6:30 am – 7:30 am.
Topic: Staying Safe in Health Interactions and Health Environment for Palliative Care Providers.

Those who are interested can join with us and participate in next session by filling up the form here


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