Telehealth & TB
The Covid-19 lockdowns significantly shifted perspectives on telehealth, forcing providers, patients and payers to rethink the feasibility of this mode of care. Eliminating the need for nurses or patients to travel, the telehealth version of directly observed therapy (DOT), known as electronic DOT (eDOT), has been explored as a possible alternative to the more travel intensive treatment of in-person DOT.
Starting in July 2017, researchers began studying rates of adherence for in-person DOT compared with eDOT among 216 randomized patients treated for TB in New York City. Data was collected through April 2021 and shows eDOT was as effective as traditional DOT for observing medication ingestion. With completed doses for eDOT measuring 89.9% and for DOT 87.2%, eDOT easily clears the 10% noninferiority limit.
Researchers concluded, “This trial provides evidence supporting the efficacy of this digital adherence technology, and for the inclusion of electronic DOT in the standard of care.”
In addition to being effective in supporting medication adherence, eDOT creates significant logistical efficiencies and cost savings, based on results experienced by The DuPage County Health Department in Illinois. From January 2013 to December 2014, DuPage County Staff used smartphones and personal computers to provide an early form of eDOT.
As reported in High Impact Prevention: “Throughout the treatment course, eDOT patients saved an average of 9,499 travel miles. In total, the eDOT program saved 579 hours in staff time, representing $144,750 and $13,159 in travel miles/expenses (or $147,288 and $13,390, respectively, in 2016US$, or an average of $14,355/patient).”
The efficiencies created for TB treatment by eDOT/VDOT can be further expanded when health departments pair these tools with an electronic health record like ezEMRx. ezEMRx actually includes a telehealth component and automates workflows around documentation, monitoring and reporting.
Case managers open the patient’s record and all previous information is automatically populated, allowing them to spend less time on data entry and more time on counseling patients and building rapport, while reducing staff travel time allows them to satisfy more DOT care objectives.
At the department level, streamlined operations enable greater throughput, which in turn enables more revenue via state funding. That funding which can support hiring additional staff and satisfying more care objectives. Funds can also be channeled into bringing on more highly credentialed staff.
For example, nurse practitioners can work more closely with MDs, generating more billable services, which, again can support a wider mission.
Automation combined with eDOT can help support a virtuous cycle where more and more people can be treated and guided to better health.