As the healthcare market struggles to understand how digital health concepts will eventually impact care, it is inspiring to see how our nation’s public health professionals are boldly implementing cutting edge technology to solve one of healthcare’s most complex issues: medication adherence.
To date, the most effective method for securing consistently high medication adherence is a daily face-to-face observation of the patient taking medication. This technique, known as Directly Observed Therapy (DOT), is expensive and burdensome. Many tuberculosis (TB) control programs have used video to make the process more efficient -- and have succeeded dramatically.
The National Tuberculosis Controllers Association (NTCA) brings together TB control programs from across the U.S., including state, city, county, and territory leaders. When the organization was founded in 1995, there were more than 22,000 new cases of TB annually. Thanks in large part to the diligent implementation of DOT for TB medications, the prevalence of TB has been dramatically reduced to less than 10,000 cases annually.
This year’s conference was the first in which a broad mix of jurisdictions presented solid evidence that video technology is helping them achieve radically high rates of medication adherence. Video DOT is used to refer to the practice of a patient taking their medication on video, either as part of a live interaction with a healthcare professional, or “asynchronously,” where a video recording is submitted and reviewed later.
- The State of Rhode Island presented a comparison of their use of traditional DOT, live video DOT, and asynchronous DOT. Greater than 95.9 percent adherence was achieved in all three methods. Rhode Island is unique in that the state used emocha asynchronous DOT to divide workload between public health workers and a local private clinic.
- Harris County (TX), a pioneer in asynchronous video DOT, presented an analysis of more than 160 patients who used the technology over a three year period. Adherence rates averaged from 92-94 percent over the period. A cost analysis shows more than $160,000 saved over the past two years, or more than $1,300 per patient. Harris County also displayed their success in the wake of Hurricane Harvey, during which 59 out of 61 patients were 100 percent adherent.
- Fresno County (CA) has become a true thought-leader in video DOT. Their comprehensive asynchronous video DOT analysis was selected for oral presentation and detailed more than $80,000 saved in year one of their program, with an average adherence of 92 percent. Joe Prado, Community Health Division Manager, Ge Vue, TB Program Manager, and the team at Fresno County took a deeper look and brought in county Environmental Services professionals, who calculated that emocha helped county workers avoid 110,000 miles of driving, resulting in a reduction of 42 metric tons of carbon dioxide.
- University of California, San Diego presented a study involving 274 participants in multiple California counties. The thorough study showed high rates of adherence, demonstrated cost savings, and high patient acceptability. The authors also proved that, due to the flexibility of video DOT, more doses were able to be observed than by using traditional in-person DOT.
- Chihuahua, Mexico presented the first study of video DOT out of Mexico. The 10-patient cohort achieved 879 out of 921 expected doses using the Spanish language version of emocha, for a 95.4 percent adherence rate. Drs. Perez and Cervantes from Amor pro TB found that nine of the ten patients enjoyed using the technology, and are currently preparing for a broad roll out.
- Denver Health (CO) released data from 57 patients using asynchronous video DOT in the Denver area. The detailed data showed greater than 95 percent adherence and a dose-by-dose accounting of nearly 10,000 in-person and video-observed doses. The findings demonstrated that detailed adherence data is possible to capture even with limited resources, which could be significant for payers in the commercial market who are assessed for medication adherence.
- Oregon State University set a great example for private providers and student health services everywhere by expanding a latent tuberculosis (LTBI) screening and treatment program. More than 70 percent of students screening positive for LTBI accept treatment. OSU uses emocha to perform DOT on students traveling during or in-between semesters.
The results presented at the NTCA conference are among many recent advancements in our understanding of the benefits of technology-assisted observed dosing. Public health departments and world-class researchers are proving that adherence can be measured based on whether patients actually take their medication. Johns Hopkins clinician-scientists have recently published a meticulous study of video DOT usage in three counties in Maryland. In late 2017 the CDC published separate studies of asynchronous video DOT saving lives in Puerto Rico and Texas.
Most importantly, these public health departments are proving that it is possible to use technology to better serve patients facing potentially deadly consequences. Video DOT offers a patient-centric approach to high levels of adherence. The broader healthcare system, including hospitals, pharmacies, and payers, should look to public health where -- despite limited funding -- innovation is helping to drive positive patient outcomes and save resources.