A newly expanded experiment using mobile video to streamline care for tuberculosis patients has been shown to cut costs and benefit patients with better, more flexible treatment.
Developed by Dr. Richard Garfein at the University of California, San Diego, the solution involves using a smartphone application for patients with tuberculosis to videotape themselves taking their medications properly; the video is time-stamped and sent to a server, where a public health worker can then monitor multiple patients.
Traditionally, tuberculosis — a highly communicable airborne disease that is required to be reported and monitored by local public health departments — has called at least six months of a medicine regime. Patients are normally required to take their medications in front of a public health worker: either having a worker come to their home, or coming to a clinic to pick up medications daily, to ensure adherence to medication protocols and prevent the spread of the disease and the development of medication-resistant strains. Garfein thought he could use mobile technology to address the logistics, disruption and expense of that daily in-person contact.
The VDOT, or Video Directly Observed Therapy, has won support from the Verizon Foundation, which is Verizon Communications’ 501(c)3 organization focused on supporting the use of wireless technology in addressing problems for underserved populations in education and healthcare, as well as energy management. Garfein’s project was also funded by the National Institutes of Health and Alliance Healthcare Foundation.
According to Garfein, there are about 8.8 million new cases of tuberculosis worldwide each year, and the U.S. has about 10,000 cases. California is the U.S. state with the highest incidence of TB, and it is among four states with more than 500 cases identified in the past year.
However, the long treatment regimen, with potential unpleasant medication side effects, and the time necessary to check in with public health workers all work against patients actually completing treatment successfully.
“Adherence is critical,” Garfein said, noting that if patients do not take their medications “consistently and completely,” TB can re-emerge and develop drug resistance.
According to the Verizon Foundation, the VDOT pilot program ran from July 2011 to August 2012 and concluded with 30% savings on transportation and staffing costs for the health departments involved. It also increased the number of patients who stuck to the proper medication treatment by nearly 50%. More than 93% of the required doses were observed via videos made by the patients, and 100% of the patients said they would recommend VDOT over face-to-face observation. The program already has international interest, with the London city health department exploring participation.
Anthony Llompart, director of health care programs with the Verizon Foundation, said that TB treatment with in-person observation can cost as much as $30,000 per year, per patient with travel costs and personnel costs factored in.
Initially, Garfein’s project was server-based. Llompart said that Verizon Foundation provided cloud access that meets regulations for healthcare privacy and security, as well as smartphones to provide to patients.
Llompart noted that TB patients are “typically the last to receive this type of solution. … This can help the level of health care of under-served patients, and improve the actual quality of health care.”
The Verizon Foundation has also committed to provide seed devices for as many health departments as are interested.
“We’re helping scale this to San Francisco, and New York, and the health department in San Diego,” Llompart said. “This is a perfect example of one of our partnerships.”
You can watch a live demonstration of the VDOT technology in this video (demo at 15:40):