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Advances in telehealth help join the DOTs for tuberculosis patient care

Fuseworks Media
Fuseworks Media

The delivery of tuberculosis treatment to patients around Auckland has greatly improved thanks to video conferencing technology that has enabled virtual health consultations resulting in optimal use of public health staff resources and time.

Around 160 new cases of tuberculosis are diagnosed in Auckland every year. This serious disease requires prolonged treatment for at least 6 months, sometimes longer. The treatment often includes resource intensive Directly Observed Therapy (DOT) where a trained observer must watch patients swallow each dose of their daily medication.

The Auckland Regional Public Health Service (ARPHS) partnership with telehealth specialists, Vivid Solutions, uses industry-leading Polycom video collaboration technology to introduce face-to-face video conferencing to replace in-person DOT for some patients. Known as TeleDOT, nurses no longer have to physically drive to every single patient’s home or workplace to observe them taking their medication.

Prior to TeleDOT technology, a 10 minute visit could take up to an hour of a nurse’s valuable time due to the travel involved and traffic congestion on Auckland’s roads.

Thanks to TeleDOT, patients and nurses can now communicate over video via a secure and confidential live feed on their tablets, iPads, laptops or smart phones. A new ‘auto record’ function is now also available, where patients can upload video footage of themselves taking their medicine to Vivid’s secure portal for health staff to then watch at a more suitable time.

Three years on from an initial pilot program, the partnership between ARPHS, Vivid and Polycom has delivered impressive results and is being applauded as an example of "healthcare of the future".

Prior to TeleDOT, around 30 per cent of tuberculosis patients used to receive DOT treatment in Auckland. But thanks to the partnership, that has now increased to 50 per cent, with half of those receiving TeleDOT and half receiving traditional face-to-face visits.

ARPHS medical officer of health, Dr Cathy Pikholz, says a total of 111 TB patients over the last three years have now taken their medication by TeleDOT, with numbers steadily growing each year. Up to 60 patients are expected to use TeleDOT in 2016.

"TeleDOT has been well received by clients," Dr Pikholz says. "It is much less intrusive than walking into a client’s home, workplace or place of study to watch them take their medication.

"Clients also have greater autonomy and a greater sense of control over their TB treatment. They have greater flexibility over the timing of taking their medication, which is particularly good for shift workers and clients who prefer to take their medication late at night before they go to bed. Overseas travel no longer means an interruption to DOT - as long as the client can log on to the internet, they can continue to record themselves taking their medication."

In addition to achieving a 20 per cent increase in the number of patients receiving DOT within existing nursing staff resources, the technology also frees up ARPHS staff time for other important tasks.

"The time saved by TeleDOT allows public health nurses to concentrate on the responsibilities associated with case management and contact tracing of TB cases, as well as responsibilities associated with other infectious diseases and outbreaks," Dr Pikholz explains.

TeleDOT has now been used successfully in both drug susceptible and multi-drug resistant cases of TB, although ARPHS says it won’t replace traditional DOT entirely as there will always be a need for face-to-face monitoring of some patients.

"In summary, TeleDOT has allowed a difficult and prolonged medication management pathway to be made easier for the client, and has achieved sustainable financial, environmental and staff resource efficiencies for ARPHS."

Vivid Solutions chief executive Simon Hayden says TeleDOT is a great example of how district health boards around New Zealand can deliver healthcare of the future, today.

"This transformational technology allows DHBs to deliver chronic disease management via our ‘Home Health’ video collaboration solution.

"The new ‘auto record’ function is a key. Patients and nurses can connect into one of 10 virtual meeting rooms at their convenience via Polycom RealPresence Web Suite and upload or view the necessary footage."

Hayden says 21st century collaboration technologies like the video solution being deployed by ARPHS is the way of the future and can make a huge difference to an organisation’s carbon footprint and business costs by reducing the need to travel for meetings or consultations.

"All of our services, including TeleDOT, are supported by a secure, high-speed, large capacity nationwide communications network and infrastructure. TeleDOT can easily be applied by other DHBs right across New Zealand."

Polycom Asia Pacific Director for education and healthcare Mei Lin Low says New Zealand’s healthcare industry is changing rapidly and healthcare technology is playing a significant role in this.

"Ever increasing demands on healthcare budgets are accelerating the need for change and driving the adoption of telehealth as providers seek to deliver quality care while reducing the cost of transporting patients to hospitals or sending specialists into the field.

"For healthcare providers like ARPHS and its Direct Observed Therapy (DOT) programme, deploying Polycom video collaboration technology makes strategic and financial sense.

"For patients being treated for tuberculosis, it puts the management of their health back into their own hands, providing more flexibility, reducing unnecessary travel time and expenditure. Likewise, for health professionals this transformational technology means being able to provide equity of access for all, continuity of care and the delivery of vital information that accelerates decision-making where it’s needed most."

According to Polycom’s recent global Healthcare 2025 survey, funding and access to healthcare are the two biggest roadblocks preventing the development of more efficient and effective healthcare infrastructures.

The study, which polled more than 1200 healthcare industry professionals from around the world, also revealed that technology developments such as mobile, the Internet of Things (IoT) and big data, offer the most promising ways to overcome healthcare bottlenecks by 2025.

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