California Public Health Departments Remotely Treat Tuberculosis: Outcomes & Opportunities

Abstract

Background and Purpose: Using video-based directly observed therapy (VDOT) to remotely monitor tuberculosis (TB) patients’ treatment is now a viable option due to the advancement and expansion of technology. This study determined the utilization levels, benefits, barriers, and outcomes of California public health departments using VDOT to treat TB. Methods: Interviews (n=7) with pilot site staff in California and a survey (n=56) were used for data collection. In 2015 the survey was disseminated to attendees of the California Tuberculosis Control Association annual conference. Results: Almost 27 percent (n=15) of survey respondents were using VDOT. Reported benefits were high and centered on patient and provider satisfaction, cost savings, and staff safety. The highest concern was reimbursement, specifically that California’s Medicaid program, Medi-Cal, reimburses for in-person DOT but not VDOT. Conclusion: VDOT is a practical and effective option for providing DOT as it has many benefits with minimal concerns. Reimbursement equal to that of in-person DOT and the continued technological improvements should alleviate the existing hindrances that are currently preventing many health departments from implementing VDOT or expanding their existing program. Satisfaction is high, outcomes are positive, and VDOT is cost effective so efforts should be made to break down the barriers to expansion.