Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.

<h4>Background</h4>THE USE OF DIRECT OBSERVATION TO MONITOR TUBERCULOSIS TREATMENT IS CONTROVERSIAL: cost, practical difficulties, and lack of patient acceptability limit effectiveness. Telehealth is a promising alternative delivery method for improving implementation. This study aimed t...

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Autores principales:	Victoria A Wade, Jonathan Karnon, Jaklin A Eliott, Janet E Hiller
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3d8098f31aee42d494f466e0f86b9ff6
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spelling	oai:doaj.org-article:3d8098f31aee42d494f466e0f86b9ff62021-11-18T08:06:55ZHome videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.1932-620310.1371/journal.pone.0050155https://doaj.org/article/3d8098f31aee42d494f466e0f86b9ff62012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23226243/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>THE USE OF DIRECT OBSERVATION TO MONITOR TUBERCULOSIS TREATMENT IS CONTROVERSIAL: cost, practical difficulties, and lack of patient acceptability limit effectiveness. Telehealth is a promising alternative delivery method for improving implementation. This study aimed to evaluate the clinical and cost-effectiveness of a telehealth service delivering direct observation, compared to an in-person drive-around service.<h4>Methodology/principal findings</h4>The study was conducted within a community nursing service in South Australia. Telehealth patients received daily video calls at home on a desktop videophone provided by the nursing call center. A retrospective cohort study assessed the effectiveness of the telehealth and traditional forms of observation, defined by the proportion of missed observations recorded in case notes. This data was inputted to a model, estimating the incremental cost-effectiveness ratio (ICER) of telehealth. Semi-structured interviews were conducted with current patients, community nursing and Chest Clinic staff, concerning service acceptability, usability and sustainability. The percentage of missed observations for the telehealth service was 12.1 (n = 58), compared to 31.1 for the in-person service (n = 70). Most of the difference of 18.9% (95% CI: 12.2 - 25.4) was due to fewer pre-arranged absences. The economic analysis calculated the ICER to be AUD$1.32 (95% CI: $0.51 - $2.26) per extra day of successful observation. The video service used less staff time, and became dominant if implemented on a larger scale and/or with decreased technology costs. Qualitative analysis found enabling factors of flexible timing, high patient acceptance, staff efficiency, and Chest Clinic support. Substantial technical problems were manageable, and improved liaison between the nursing service and Chest Clinic was an unexpected side-benefit.<h4>Conclusions/significance</h4>Home video observation is a patient-centered, resource efficient way of delivering direct observation for TB, and is cost-effective when compared with a drive-around service. Future research is recommended to determine applicability and effectiveness in other settings.Victoria A WadeJonathan KarnonJaklin A EliottJanet E HillerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 11, p e50155 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Victoria A Wade Jonathan Karnon Jaklin A Eliott Janet E Hiller Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.
description	<h4>Background</h4>THE USE OF DIRECT OBSERVATION TO MONITOR TUBERCULOSIS TREATMENT IS CONTROVERSIAL: cost, practical difficulties, and lack of patient acceptability limit effectiveness. Telehealth is a promising alternative delivery method for improving implementation. This study aimed to evaluate the clinical and cost-effectiveness of a telehealth service delivering direct observation, compared to an in-person drive-around service.<h4>Methodology/principal findings</h4>The study was conducted within a community nursing service in South Australia. Telehealth patients received daily video calls at home on a desktop videophone provided by the nursing call center. A retrospective cohort study assessed the effectiveness of the telehealth and traditional forms of observation, defined by the proportion of missed observations recorded in case notes. This data was inputted to a model, estimating the incremental cost-effectiveness ratio (ICER) of telehealth. Semi-structured interviews were conducted with current patients, community nursing and Chest Clinic staff, concerning service acceptability, usability and sustainability. The percentage of missed observations for the telehealth service was 12.1 (n = 58), compared to 31.1 for the in-person service (n = 70). Most of the difference of 18.9% (95% CI: 12.2 - 25.4) was due to fewer pre-arranged absences. The economic analysis calculated the ICER to be AUD$1.32 (95% CI: $0.51 - $2.26) per extra day of successful observation. The video service used less staff time, and became dominant if implemented on a larger scale and/or with decreased technology costs. Qualitative analysis found enabling factors of flexible timing, high patient acceptance, staff efficiency, and Chest Clinic support. Substantial technical problems were manageable, and improved liaison between the nursing service and Chest Clinic was an unexpected side-benefit.<h4>Conclusions/significance</h4>Home video observation is a patient-centered, resource efficient way of delivering direct observation for TB, and is cost-effective when compared with a drive-around service. Future research is recommended to determine applicability and effectiveness in other settings.
format	article
author	Victoria A Wade Jonathan Karnon Jaklin A Eliott Janet E Hiller
author_facet	Victoria A Wade Jonathan Karnon Jaklin A Eliott Janet E Hiller
author_sort	Victoria A Wade
title	Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.
title_short	Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.
title_full	Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.
title_fullStr	Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.
title_full_unstemmed	Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.
title_sort	home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/3d8098f31aee42d494f466e0f86b9ff6
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Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation.

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