Perhaps we’ll never run out of ideas to use a telephone, the 1876 invention of Alexander Graham Bell. From communication to gaming, entertainment to financial transaction, medical imaging to global positioning, and now structured healthcare delivery.
Last week, researchers reported in the October issue of Archives of General Psychiatry that in a four-year randomized study, patients of depression were shown to have benefited significantly from a structured telephone programme to manage the condition, with only a moderate increase in healthcare costs compared with those who received the usual care.
Cheerful cost benefits
“Depression has large economic effects outside the healthcare system, including disability, lost work productivity, reduced educational attainment and relationship disruption. Ideally, decisions about the value of depression care programmes should consider these broader economic effects,” write the authors. Since organized treatment programmes for depression have proven to be effective, it is important to balance the benefits and costs for large-scale implementation.
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The economic costs of this ailment, which the World Health Organization (WHO) predicts will be the second leading cause of health impairment worldwide by 2020, seem unmeasurable in India, largely because of an anaemic attitude to collecting epidemiological data. This prevents us from getting a grip on the prevalence of the disorder. It is further compounded by our cultural hesitation on psychiatric conditions: Reporting on depression is taboo; seeing a medical doctor slaps a social stigma on the individual.
Why India should call
On 28 September, the open-source international journal PLoS One published the largest ever population-based study from India on the prevalence of depression. It found that among urban south Indians, 15.1% suffered from the disorder. So that calls for considering a telephone programme for psychotherapy in a country which is not only witnessing an explosion in mobile telephony, but also a rise in psychiatric disorders as it grapples with demographic transition.
The lead author of the telephone study, Gregory Simon of the Group Health Research Institute, Seattle, believes there are three reasons why a telephone programme would have higher participation than traditional in-person psychotherapy. “First, therapy by phone is simply more convenient. Second, avoiding in-person visits to a therapist’s office would help to circumvent stigma. Third, our programme included fairly aggressive outreach (therapists calling clients to encourage participation) and that’s certainly not the norm for in-person psychotherapy,” he writes in an email.
Though Simon’s study did not directly compare the phone programme with in-person psychotherapy, he says the participation rates in their programme were much higher than usually seen with in-person therapy.
Programming to pay
All this doesn’t mean the public healthcare system, already creaking, needs to take on any additional burden. The problem, the solution and the environment lend themselves to a variety of business models, which some are already exploring, though telehealthcare is in its infancy in India. One example is the start-up, mDhil Llc, founded by former Goldman Sachs financial analyst Nandu Madhava, which provides basic healthcare advice (diabetes management, maternal and sexual health, post-surgery care) on mobile phones. Certain non-profit organizations already offer telephonic counselling. Other entities are trying to work out viable revenue models. One Delhi-based entrepreneur I spoke to, also looking to enter healthcare, noted this logistical issue for telehealthcare: How do you prescribe medicines on the phone and charge the customer?
Arguably, not all therapies are amenable to such telephonic delivery. However, mental healthcare seems a case with fewer such logistical barriers—and Simon’s study has proven its benefits compared with traditional treatment.
The writer is Mint’s deputy bureau chief in Bangalore.
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