Smartphone technology has given San Diego County health officials a
less invasive way to monitor the treatment of tuberculosis patients.
Through a partnership with the University of California, San Diego (UCSD) and Verizon, the county is distributing a number of smartphones to TB patients. The users record themselves taking their daily prescriptions and then wirelessly transmit the videos to the county for review.
Called Video Directly Observed Therapy (VDOT), the program has been around for a few years. The first smartphones were introduced to the program in 2010, giving patients the ability to take their medicine and record video at their convenience. That ended a couple of years ago. A recent grant from Verizon has funded a new trial of the program, which includes various improvements to the system.
The system's backend architecture has been upgraded so that multiple health departments can feed information into the same database. The new version also has expanded data fields for health workers watching the videos and the program now works on multiple types of Android-based smartphones.
County workers have in the past have used landline-based phones and still photos to evaluate patient TB treatment. That evaluation method, along with in-home visits continues, but requires patients to take their medication on the schedule of health officials, normally during business hours.
According to experts, while TB patients are not required to be observed taking their medicine, poor overall compliance with lengthy, year-long treatment regimes has led to observation being recommended. Patients typically need to take from six to 12 pills per day, some of which produce unwelcome side effects, including upset stomach.
Kathy Moser, director of the TB and refugee health branch in San Diego County, felt the flexibility of smartphone video as opposed to real-time phone conversations and pictures or in-home visits has been a benefit for both staff and patients.
"Patients feel like someone isn't watching them and no one is coming to their homes, so it's had that advantage," Moser said of the VDOT system. "And our staff like it, especially for people who live quite some distance away. We're a big county, so if you have someone in the furthest reaches, it's quite a bit of travel time."
The VDOT system was created by Richard Garfein, a professor with the Department of Medicine at UCSD and developers from Calit2, a research and development arm of the university.
The initial development work on the VDOT smartphone system was funded through a $275,000 NIH grant. The smartphone app and backend programming took approximately six months to develop, but the entire process took about two years. It was pilot tested from 2010-2011 with 43 patients in San Diego County and nine in Tijuana, Mexico.
Garfein said he got the idea of using smartphones from observing Washington State and San Diego's nine-month pilot study involving 33 patients in 2004. That pilot used landline phones and photos to evaluate patients. Garfein noted that governments were able to save approximately 28,000 miles of transportation and 800 hours of manpower during the study, which translated to about $25,000 in savings.
At first Garfein wanted to continue doing live interactions with patients,
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