Telehealth-Based Directly Observed Therapy Proves Effective in Guam for Tuberculosis Treatment

Original Source: Center for Connected Health Policy


CMS Releases Proposed CY 2020 Physician Fee Schedule

Yesterday the Centers for Medicare and Medicaid Services (CMS) released their proposed Calendar Year 2020 Physician Fee Schedule, aiming to reduce administrative burden on physicians, and make it easier for patients to access value-based care.  Among the changes, CMS has proposed steps to help clinicians better manage chronically ill patients as they transition from the hospital to the home through care management services.  CMS is also proposing to add three new codes for a bundled episode of care for treatment of opioid use disorder, among other changes.

Comments on the proposal are due Sept. 27, 2019.

Stay tuned for an in depth analysis from CCHP in next week’s In Focus.  

Telehealth-Based Directly Observed Therapy Proves Effective in Guam for Tuberculosis Treatment

In Guam, tuberculosis (TB) occurs at a high incidence rate, with the World Health Organization estimating 60 cases per 100,000 members of the population. In response, the Guam Department of Public Health and Social Services (DPHSS) began partnering with telehealth vendors in 2018 to begin implementing video directly observed therapy (vDOT) into TB treatment and prevention programs. Directly observed therapy (DOT) is an established strategy for ensuring adherence to the strict medication regimen necessary in the treatment of TB. DOT requires a patient to regularly meet with a health care worker who observes the patient taking their TB medication and records the incident. vDOT incorporates telehealth to allow patients to record themselves taking their medication and forward the recording to health workers to confirm adherence.

According to Chima Mbakwem, TB Control Program Manager at the Guam DPHSS, the program “fostered a series of successes” between August 2018 and January 2019. Results of the program have so far included 1,417 confirmed doses of medication distributed among 35 patients, $21,255 in staff time savings, $3,457 in savings associated with lower spending on gasoline, and 700 saved hours of driving time.

Telehealth has, to date, had a successful history of use in vDOT for TB treatment. A recent study from the United Kingdom on the effectiveness of the strategy showed that, during the first two months of treatment, patients using vDOT successfully achieved over 80% of scheduled observations compared to 31% for patients receiving traditional DOT. Another study in Maryland showed that vDOT is at least comparable to DOT in ensuring medication adherence and generated cost savings of $1,391 per patient for a standard 6-month treatment regimen. In 2016, a Puerto Rico based TB treatment program reported the use of asynchronous vDOT allowed patients and providers to overcome inconsistencies in internet connectivity and saved Puerto Rico Department of Health clinic staff approximately 1.5 hours of observation time per day.

For more information on vDOT, read the following reports from the Center for Connected Health Policy- California Public Health Departments Remotely Treat Tuberculosis: Outcomes & Opportunities and Challenges and Recommendations on Using Telehealth for Directly Observed Therapy in Treating Tuberculosis.