ABSTRACT
Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems’ perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (?) 0.59 million to ? 2.59 million [1United States Dollars (US $) = ? 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.
ABSTRACT
Background: The massive toll due to COVID-19 has resulted in stretching of resources of healthcare systems and has led to unique demands on healthcare workers (HCWs) that are not seen in usual practice, which predispose them to mental health problems. The aim of the study was to assess mental health status in healthcare workers posted in COVID hospital as Mental health issues may impact decision making among HCWs, leading to medical errors and may also impact wellbeing in the long term. Methodology: This was a cross-sectional study. 799 HCWs posted in the COVID-19 wing of a tertiary care hospital were studied. Socio-demographic details were recorded and a Gujarati version of GHQ-28 was applied. A total score of ? 4 on GHQ-28 was considered indicative of ‘caseness’ or ‘psychiatric morbidity’. Association of outcomes like total GHQ-28 score, and responses on individual items of GHQ indicative of fatigue, sleep disturbances, stress, irritability, anxiety and others with variables like age, gender, profession, years of experience, marital status and family type was assessed. Results: 40 individuals (5%) reported at least one of the symptoms. The most commonly reported symptom was sleep disturbance, reported by 38 participants (4.75%), followed by stress in 34 participants (4.25%), fatigue in 29 participants (3.62%) and anxiety in 24 (3.00%). Decision-making problems, hopelessness, death wishes/suicidal ideation were rare. Conclusion: Age > 45 years was a significant predictor for GHQ-28 total score being ?4 and stress, experience > 5 years was statistically significantly associated with sleep disturbance, and being female was a significant predictor for fatigue.
ABSTRACT
Background: To analyse adverse drug reactions (ADRs) reported in patients prescribed psychiatric medications at tertiary care hospital.Methods: ADRs reported in psychiatric patients between January 2011 to June 2017 were analyzed for demographic details, causal drugs, system organ classification, causality assessment (WHO-UMC criteria and Naranjo’s scale), preventability (Modified Schumock and Thorton’s criteria) and severity (Hartwing scale).Results: A total 4368 ADRs were reported during study period, out of which 658 (15.06%) were in psychiatric patients. The mean age of patients was 38±13.34 years and men (57.3%) were most commonly affected than women (42.7%). The most common causal drug groups were antidepressants (29.48%) followed by antipsychotics (23.12%) which include drug fluoxetine (33.9%) and olanzapine (34.3%) respectively. The most common system involved were central nervous system (32.8%) followed by gastrointestinal system (22.8%). Most of ADRs (42.7%) were observed after one month of therapy and showed possible (77%) causal relation with drug therapy. Majority of ADRs (77.4%) were not preventable and mild in nature (83.3%).Conclusions: ADRs are commonly seen in psychiatric patients. Hence, their monitoring and assessment in these patients who require multidrug and long-term therapy may help improve patient management.