Psychiatric Medications Procurement at Primary Health Centers (PHCs) in Tumkur: Insights from an Effectiveness Implementation Hybrid Randomized Controlled Trial on Mental Health Tele-mentoring of Primary Care Doctors (PCDs)

Abstract

Background: Psychiatric disorders contribute significantly to the global burden of disease, especially in rural areas with limited healthcare resources. Psychiatric medications are essential for managing these conditions, but their availability and appropriate use remain inadequate at Primary Health Centers (PHCs) in India. Methods: This is a secondary analysis conducted within a larger cluster randomized controlled trial (RCT) evaluating the add-on Online Mental Health Training (OMHT) for primary care doctors (PCDs) compared with training as usual (TAU). The primary outcomes of the RCT were patient-level diagnostic and treatment concordance with psychiatrist assessments, reported separately. In this article, we focus on psychiatric medication requisition patterns as a proxy for clinical practice improvement among PHCs in Tumkur District, Karnataka, India. Psychiatric medications procurement data were extracted from a centralized drug procurement portal across three phases: Pre-training, training and assessment, and post-training. Results: Within-group analysis over time showed a statistically significant increase in the proportion of PHCs procuring amitriptyline in both the OMHT arm (p = .01) and the TAU arm (p = .03). Additionally, in the OMHT arm, there was a significant increase over time in the proportion of PHCs procuring alprazolam (p = .03) and clonazepam (p = .02).  In the between-group comparison of total quantities procured during the combined training and post-training phases, the OMHT arm demonstrated significantly higher procurement of escitalopram (p < .01) and risperidone (p