In a recent study, Canadian infectious disease & public health experts reported that virtual tuberculosis (TB) clinics were about as effective as standard outpatient TB clinics.
We’ve covered a number of projects that use digital health to try to tackle TB, a disease where effective management can be very resource and time intensive. For example, the miLINC platform deployed in South Africa helps connect field workers with centralized labs and public health officials, with specifically designed apps tailored to different users’ needs. Once you diagnose TB, adherence to therapy is critical. To simplify directly observed therapy, Baltimore based eMocha developed a smartphone-based virtual directly observed therapy app.
In a study recently published in PLoS One, researchers described the outcomes of a virtual TB clinic set up within an academic hospital in comparison to traditional outpatient TB clinics. The virtual clinic was initially set up to address issues with declining expertise in TB management among physicians as well as challenges in reaching patients in far-flung, isolated areas. These clinics were set up to manage patients from afar with care plans being carried out by local clinicians.
A total of 150 patients in the virtual clinic and 691 patients in the outpatient clinic were included. They compared outcomes across nearly thirty quality indicators dealing with both processes of care and outcomes. Overall, the virtual clinic was comparable to the outpatient clinics on the vast majority of indicators;
Indicators included process metrics like following patients out to three negative smears (93% virtual clinic vs. 55% in outpatient clinics, p = 0.001) and getting cultures and x-ray at the end of initial treatment phase (50 % vs. 78%, p = 0.01; 52% vs. 68%, p<0.05). Outcome indicators included the number of patients treated with directly observed therapy (100% vs. 95%, p=0.004) and TB related death (no difference).
Granted, this is in some ways comparing apples to oranges as these clinics are set up to address different populations with very different needs. So there’s certainly a fair amount of bias embedded in this study that would be difficult to untangle. That said, it’s important to know that similar outcomes to standard care can be achieved with this virtual clinic design. The challenges this virtual clinic is addressing in Alberta are certainly present in many other places.
Long et al. Do “Virtual” and “Outpatient” Public Health Tuberculosis Clinics Perform Equally Well? A Program-Wide Evaluation in Alberta, Canada. PLoS One. Full Text