Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods Appraisal of Video Directly Observed Therapy

Samuel B Holzman, Avi Zenilman, Maunank Shah, Samuel B Holzman, Avi Zenilman, Maunank Shah

Abstract

Background: Directly observed therapy (DOT) remains an integral component of treatment support and adherence monitoring in tuberculosis care. In-person DOT is resource intensive and often burdensome for patients. Video DOT (vDOT) has been proposed as an alternative to increase treatment flexibility and better meet patient-specific needs.

Methods: We conducted a pragmatic, prospective pilot implementation of vDOT at 3 TB clinics in Maryland. A mixed-methods approach was implemented to assess (1) effectiveness, (2) acceptability, and (3) cost. Medication adherence on vDOT was compared with that of in-person DOT. Interviews and surveys were conducted with patients and providers before and after implementation, with framework analysis utilized to extract salient themes. Last, a cost analysis assessed the economic impacts of vDOT implementation across heterogeneous clinic structures.

Results: Medication adherence on vDOT was comparable to that of in-person DOT (94% vs 98%, P = .17), with a higher percentage of total treatment doses (inclusive of weekend/holiday self-administration) ultimately observed during the vDOT period (72% vs 66%, P = .03). Video DOT was well received by staff and patients alike, who cited increased treatment flexibility, convenience, and patient privacy. Our cost analysis estimated a savings with vDOT of $1391 per patient for a standard 6-month treatment course.

Conclusions: Video DOT is an acceptable and important option for measurement of TB treatment adherence and may allow a higher proportion of prescribed treatment doses to be observed, compared with in-person DOT. Video DOT may be cost-saving and should be considered as a component of individualized, patient-centered case management plans.

Keywords: mHealth; medication adherence; telemedicine; tuberculosis; video DOT.

Figures

Figure 1.
Figure 1.
Schematic of data acquisition and transmission on miDOT.

References

    1. World Health Organization. Fact sheet 2017. Available at: . Accessed April 2017.
    1. Centers for Disease Control. Fact sheet 2016. Available at: . Accessed January 2018.
    1. Dieleman JL, Templin T, Sadat N, et al. . National spending on health by source for 184 countries between 2013 and 2040. Lancet 2016; 387:2521–35.
    1. Nahid P, Dorman SE, Alipanah N, et al. . Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 2016; 63:e147–95.
    1. World Health Organization. WHO Treatment Guidelines for Drug-Resistant Tuberculosis: 2016 Update. Geneva, Switzerland: WHO Press; 2016.
    1. Burman WJ, Cohn DL, Rietmeijer CA, et al. . Noncompliance with directly observed therapy for tuberculosis. Epidemiology and effect on the outcome of treatment. Chest 1997; 111:1168–73.
    1. Picon PD, Bassanesi SL, Caramori ML, et al. . Risk factors for recurrence of tuberculosis. J Bras Pneumol 2007; 33:572–8.
    1. World Health Organization. Treatment of Tuberculosis: Guidelines. 4th ed Geneva, Switzerland: WHO Press; 2010.
    1. Hopewell PC, Pai M, Maher D, et al. . International standards for tuberculosis care. Lancet Infect Dis 2006; 6:710–25.
    1. Hodge JH, Anderson E, Gayle N, Larson L. Tuberculosis Control Laws and Policies: A Handbook for Public Health and Legal Practitioners Atlanta, GA: The Centers for Disease Control and Prevention; 2009. Available at: . Accessed 10 October 2017.
    1. Karumbi J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev 2015:CD003343.
    1. Pasipanodya JG, Gumbo T. A meta-analysis of self-administered vs directly observed therapy effect on microbiologic failure, relapse, and acquired drug resistance in tuberculosis patients. Clin Infect Dis 2013; 57:21–31.
    1. Zhang H, Ehiri J, Yang H, et al. . Impact of community-based DOT on tuberculosis treatment outcomes: a systematic review and meta-analysis. PLoS One 2016; 11:e0147744.
    1. World Health Organization. Guidlines for Treatment of Drug-Suseptible Tuberculosis and Patient Care: 2017 Update. Geneva, Switzerland; World Health Organization; 2017.
    1. Sagbakken M, Bjune GA, Frich JC. Humiliation or care? A qualitative study of patients’ and health professionals’ experiences with tuberculosis treatment in Norway. Scand J Caring Sci 2012; 26:313–23.
    1. Noyes J, Popay J. Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis. J Adv Nurs 2007; 57:227–43.
    1. World Health Organization. Digital Health for the End TB Strategy: An Agenda for Action. Geneva, Switzerland: WHO Press; 2015.
    1. Implementing an Electronic Directly Observed Therapy (eDOT) Program: A Toolkit for Tuberculosis (TB) Programs. Centers for Disease Control and Prevention; 2017. Available at: . Accessed 16 September 2017.
    1. Hemming S, Story A, Possas L, et al. . Using virtually observed treatment (VOT) for hard to manage tuberculosis: a pilot study. Paper presented at: European Respiratory Society Annual CongressBarcelona, Spain: 7–11 September 2013.
    1. Mirsaeidi M, Farshidpour M, Banks-Tripp D, et al. . Video directly observed therapy for treatment of tuberculosis is patient-oriented and cost-effective. Eur Respir J 2015; 46:871–4.
    1. Chuck C, Robinson E, Macaraig M, et al. . Enhancing management of tuberculosis treatment with video directly observed therapy in New York City. Int J Tuberc Lung Dis 2016; 20:588–93.
    1. Garfein RS, Collins K, Muñoz F, et al. . Feasibility of tuberculosis treatment monitoring by video directly observed therapy: a binational pilot study. Int J Tuberc Lung Dis 2015; 19:1057–64.
    1. Hoffman JA, Cunningham JR, Suleh AJ, et al. . Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya. Am J Prev Med 2010; 39:78–80.
    1. DeMaio J, Schwartz L, Cooley P, Tice A. The application of telemedicine technology to a directly observed therapy program for tuberculosis: a pilot project. Clin Infect Dis 2001; 33:2082–4.
    1. Wade VA, Karnon J, Eliott JA, Hiller JE. Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation. PLoS One 2012; 7:e50155.
    1. Au-Yeung KY, DiCarlo L. Cost comparison of wirelessly vs. directly observed therapy for adherence confirmation in anti-tuberculosis treatment. Int J Tuberc Lung Dis 2012; 16:1498–504.
    1. Krueger K, Ruby D, Cooley P, et al. . Videophone utilization as an alternative to directly observed therapy for tuberculosis. Int J Tuberc Lung Dis 2010; 14:779–81.
    1. Maryland Department of Health. Maryland TB guidelines for prevention and treatment of tuberculosis 2007. Available at: . Accessed May 2012.
    1. Strauss A, Corbin J.. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage Publications, Inc; 1998.
    1. Sama JN, Chida N, Polan RM, et al. . High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study. Public Health 2016; 138:101–7.
    1. Peto HM, Pratt RH, Harrington TA, et al. . Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis 2009; 49:1350–7.
    1. Reyes H, Guiscafré H, Muñoz O, et al. . Antibiotic noncompliance and waste in upper respiratory infections and acute diarrhea. J Clin Epidemiol 1997; 50:1297–304.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi