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Abstract
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For about 3 months since the pandemic broke-out, the All India Institute of Medical Sciences (AIIMS), Raipur, India was the only COVID-19 designated hospital in the entire state of Chhattisgarh. No sooner the nationwide lockdown was implemented on 25 March 2020, the outpatient services were directed to be closed as per the institutional policy. Like most departments, psychiatry services too were affected. The opioid substitution (OS) clinic, a special care delivery service (see Tikka, Singh, Mamidipalli, Purushotham, & Suchandra, 2019 for details of clinic's setting and management procedures), which the department has been successfully providing for the last 6 years, was going to be the worst hit.
Telepsychiatry took over as the alternate service provision mode for outpatient services. Online prescriptions of medicines that were permissible as per the telemedicine guidelines of India were generated. Buprenorphine naloxone combination (BNC), the formulation used for OS in the special clinic could not have been prescribed in the telemedicine mode (Medical Council of India, 2020). Following a break (of one clinic) in regular services of our OS clinic due to the institutional policy, a lot of dissatisfaction was registered by our patients in our teleconsultation platform. Therefore, we decided to resume the disrupted services of this special clinic (just after one missed OS clinic) while the general OPD services continued in telepsychiatry mode. Ensuring safety was the prime agenda of continuing the services. We developed certain standard operating procedures and shifted the clinic space to the large, open central registration area of hospital (see picture below), which was not utilized due to closure of physical OPDs. The two-way microphone/speaker cubicles of this registration area were used effectively to ensure safety (3Ds--distance, disinfection, donning appropriate personal protection gears were ensured during patients' visit to hospital).While we followed a standard operating procedure similar to that of those followed elsewhere for OS clinics in India (Basu, Ghosh, Subodh, & Mattoo, 2020) generally, some procedures, which catered to the special needs of the low resource setting of the state of Chhattisgarh that has only a few OS treatment centers and the hospital infrastructure, were unique...
Language: en |