A Health Innovation Hub Ireland (HIHI) pilot study with St James’s hospital will investigate the benefits of using technology against in-person care in tuberculosis (TB) medication adherence.
In both the United Kingdom and the United States, the standard of care to ensure TB medication compliance is Video Direct Observational Therapy (VDOTS). The patient records a video ingesting medication remotely and submits securely via software to the TB nurse.
In Ireland, a community nurse physically visits a patient with TB medication adherence, watches each take their medication and records it manually on a hard copy – this is Direct Observational Therapy (DOT).
A public health nurse visits a patient’s home either once or twice a day, within the traditional DOT system for TB in use across Ireland depending on the treatment plan.
Mobile smartphone application
By contrast, VDOTS uses a mobile smartphone application that allows patients to remotely record and send videos of every medication dose ingested.
The nurse then views the date and time stamped videos on a secure web-based client management system (CMS) that is password protected. Once a patient’s videos are uploaded to the web portal, they are automatically deleted from the smartphone.
In 2018 in Ireland, there were 315 cases of TB notified with 38.4% of total cases reported in Dublin. St James’s TB clinical nurse specialist, Lorraine Dolan approached HIHI to support the pilot study.
The pilot will run for up to 18 months and test if VDOTS is superior to DOTS in recording doses of TB treatment that up to 40 Irish patients receive. The study will assess patient quality of life, cost effectiveness and resource efficiencies e.g. nurse hours saved.
A similar UK study, published in The Lancet last year, found that the costs of providing DOT over six months were estimated at £5,700 per patient for observations five times per week and £3,420 for observations three times per week. For daily VOT over six months, costs were estimated at £1,645 per patient.
Health technology and remote care
Mary Day, CEO St James’s hospital, said: “As Ireland's largest hospital, St James's is committed to realising the full value of health technology and remote care to reduce the burden on the acute setting, achieve cost savings and empower our patients as active participants in their own care. We need this now more than ever.
“This HIHI/St James’s pilot has been driven by ingenuity on the frontline through Lorraine, with the invaluable support of Health Innovation Hub Ireland whose Dublin office is based here in St James's hospital.”
Eimear Galvin, HIHI TCD manager, said: “We opened doors in St James’s in 2018. As the acute site leader in digital health, basing part of the HIHI national network here means we can be very impactful.
"HIHI is very pleased to support this study stimulating frontline innovation and to have secured the software at no cost to the health service for the pilot duration. The need for remote care and patient management that technology such as this delivers is even more urgent now since COVID-19.”
Lorraine Dolan, TB nurse specialist and study PI, said: “TB is a curable disease; however duration of treatment is lengthy ranging from six months to two years depending on the type and location of TB. The main aim of DOT is to ensure that patients take their medications each day and most importantly complete the treatment course.
'Empowers patients'
“Although not a complete replacement for DOTs, VDOTS empowers patients who can engage with it, to live their lives normally without constraints and interruption to their working day or home life with a nurse visit. This HIHI/St James's study will be the first to offer the VDOTS option to TB patients.”
TB remains a global health threat. In 2018, 1.5 million people died from TB. TB now ranks as the leading cause of death worldwide from an infectious agent, resulting in more deaths than HIV and malaria (WHO, 2019).
Globally there were 10 million new cases of TB in 2018. Directly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s, but in some cases can be inconvenient for patients and service providers.
The use of VDOT has emerged in the last decade with the improvements in technology as an alternative approach in ensuring compliance with TB treatment.