An Evaluation of the Use of Video Technology in DOT for TB Treatment April 21, 2017 Kristen St John Rhode Island Department of Health Overview of Rhode Island Just over 1 million residents 37 miles x 48 miles 5 counties, 39 municipalities www.tbcontrollers.org 1
Overview of TB Program 1 health department for entire state TB Program Staff Program Manager TB Nurse TB Epidemiologist 2 Directly Observed Therapy (DOT) workers Clinical Services are provided by the RISE TB Clinic (Miriam Hospital) through a state funded contract Overview of TB Program Average of 20-30 cases per year All active cases receive DOT (pulmonary and extra pulmonary) Beginning of VDOT In 2014, one patient had used video DOT (VDOT) Lived 45 min from RIDOH Did not want DOT at work Completed 3 weeks in-person DOT and then used Skype for VDOT Completed therapy on time www.tbcontrollers.org 2
Situation in Summer 2015 1 DOT worker out on extended leave More patients on DOT Average of 20 patients per month on DOT (compared to 14 in 2014) Greater geographic spread of patients than previous years 50% of patients lived more than 10 miles from health department 25% lived more than 30 miles away (up to 2.5 hours round trip, with traffic) VDOT Program Overview Use of Skype and Tango approved by IT & Legal Participation in VDOT is voluntary Patient must sign a VDOT agreement No mention of TB during session Patients were eligible for VDOT after: At least 2 weeks of in-person DOT No side effects or complex comorbidities Discussion between TB clinic and DOH staff Read and signed the VDOT agreement Patient had technology Smartphone, tablet, or computer Were able to or willing to learn how to use this technology Evaluation of VDOT Program Economic evaluation of VDOT use did we save money? Treatment adherence outcomes better or worse than in-person DOT? Patient satisfaction did the patient like VDOT? www.tbcontrollers.org 3
Evaluation of VDOT Program Timeframe: June 2014 - January 2016 16 patients on VDOT during this timeframe 1 patient had multi-drug resistant (MDR) TB, requiring 2 visits per day Methods- Economic Evaluation Staff cost (in-person and VDOT) Staff time (in-person and VDOT) Mileage (in-person) No state car during this time Cost of training patients/computer/wireless hotspot (VDOT) Analyzed data by drug susceptible patients (1 visit per day) and MDR patient (2 visits per day) Methods- Treatment Adherence Compared treatment adherence for a sample of patients that received in-person DOT to those on VDOT Evaluated adherence for patients before switching to VDOT www.tbcontrollers.org 4
Methods- Patient Survey Conducted over Skype/Tango, phone or mail (whichever patient preferred) Survey included questions on: Ease of installing and using Skype/Tango Would they recommend to others? Would they prefer VDOT over in-person DOT? Results -Economic Evaluation Average cost of in-person DOT visit: Drug susceptible: $41.83 MDR: $52.13 Average cost per VDOT session: Drug susceptible: $0.89 MDR: $1.30 97.9% decrease in cost among drug susceptible patients 97.5% decrease in cost for the MDR patient Results- Economic Evaluation Administrative costs: $3,705 Included patient training, laptop, and internet hotspot costs Savings per patient: Drug susceptible: $4,531 MDR: $3,507 www.tbcontrollers.org 5
Results- Economic Evaluation Cost savings: Actual savings of $20,063 in mileage (35,954 miles) Potential savings of $51,420 in staff costs 1,000 hours staff time Results- Treatment Adherence No statistical difference in treatment adherence between in-person DOT and VDOT Most common reason for missing in-person DOT and VDOT Patient missed appointment Results- Patient Survey 9 of 16 patients completed the survey 5 of 9 patients had used a similar program before 8 of 9 patients found it Very Easy or Easy to set up the program on their phone/computer/tablet 8 of 9 patients found it Very Easy or Easy to initially use the program By the end of treatment, all patients found it Very Easy or Easy to use the program www.tbcontrollers.org 6
Results- Patient Survey All patients found it Very Easy or Easy to arrange a time for their video session All patients preferred using video sessions over in-person DOT 8 of 9 patients would recommend using video to other TB patients Conclusions No differences in treatment adherence over inperson DOT Patient experiences have been positive Potential cost savings may vary in other places, but can be substantial Greatest potential in savings if use hourly/officebased employees for VDOT RI will continue to use VDOT Starting to use an asynchronous VDOT platform Acknowledgements James Carrier Jaime Comella Carol Browning Theodore P. Marak www.tbcontrollers.org 7
Kristen St John, MPH TB Epidemiologist Office of HIV, Hepatitis, STDs, and TB Epidemiology Rhode Island Department of Health www.tbcontrollers.org 8