The Ben Franklin Tuberculosis (TB) Program, housed at Columbus Public Health (CPH), serves as the TB control unit for Franklin County, Ohio. The program is responsible for all aspects of TB surveillance, case management, and prevention and control activities. Employees include medical doctors, APRNs, registered and practical nurses, social workers and unlicensed field staff. In total, there are 17 FTEs assigned to the TB Program.
Franklin County, Ohio, is home to approximately 1.3 million people, with an average TB case rate of 6 per 100,000 population.
The decision to pilot asynchronous directly observed therapy (DOT) grew out of patient and employee frustration with synchronous electronic DOT (eDOT), conflicting schedules, and an increase in the number of TB patients on service. While real-time technology was convenient in specific situations, widespread implementation was not practical.
In spring 2017, the TB program launched an emocha pilot project. The intent was to meet the needs of Muslim patients who planned to observe the practice of fasting until sundown during the holy month of Ramadan. That year, the observance coincided with the longest days of the year, May 27 through June 25. In-person or synchronous DOT was not possible at 9:30 PM due to safety issues, union contract rules, and budgetary constraints. The pilot was immediately a success, with patient and staff feedback offering support for expansion of the program to most patients.
For the 2018 reporting period, Franklin County identified 78 active TB cases and provided testing and/or treatment to 407 associated contacts. Medical evaluation and/or treatment was provided to an additional 104 newly arrived immigrants, and 479 high-risk grade school students. This workload resulted in 6,418 face-to-face directly observed therapy (DOT) visits and 6,625 electronic DOT video submissions for the reporting period. The total number of DOT encounters increased 55% when compared to 2017, and patient adherence to DOT improved and the average cost of DOT per-patient declined.
Programs contemplating the use of eDOT should consider products that integrate video submission with mobile app access by staff. At CPH, new patients are provided face-to-face DOT while in isolation and then transitioned to video submission. This system allows for close monitoring of side effects when initiating treatment, provides the opportunity for a more comprehensive contact investigation, and allows for relationship building. With the emocha CareTeam App, CPH staff document visits as they occur and without the need to return to the office, thereby reducing mileage costs. The use of emocha and the CareTeam App has saved our program money, reduced documentation errors, and improved service delivery to our patients.
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