Telemedicine Technologies and Tuberculosis Management: A Randomized Controlled Trial
Telemedicine Technologies and Tuberculosis Management: A Randomized Controlled Trial
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DOI：
10.1089/tmj.2019.0190
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发表时间：
2019-12-02
影响因子：
4.7
通讯作者：
Wang, Chunting
中科院分区：
文献类型：
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作者：
Guo, Peng;Qiao, Wei;Wang, Chunting
背景：自20世纪90年代以来，直接观察治疗（DOT）一直是结核病（TB）的标准治疗方法，尽管它对患者和服务提供者来说都很麻烦。为提高实施，另一种具有良好潜力的交付方法是远程保健。目前的研究评估了视频直接观察治疗（VDOT）的临床和成本效益，并与DOT服务进行了比较。方法：本前瞻性随机对照试验将细菌学证实的成人肺结核患者随机分为干预组（VDOT）或对照组（DOT）。DOT和VDOT的观察数据由观察员更新，直到治疗结束或研究结束。主要结局是世界卫生组织（WHO）定义的结核病治疗结果，在北印度和英格兰进行的其他一些研究中也使用了这一结果：好（治愈并完成治疗）、差（死亡和失败）、重新安置、失去随访和其他（拒绝、不良反应、没有结核病病例）。其他次要测量是治疗依从性、患者满意度、DOT或VDOT花费的时间和费用。结果：在分析来自每个研究组的405名参与者的结果时，我们发现非常高的治疗完成率（VDOT组为96.1%，DOT组为94.6%）。观察到的两种治疗方法无统计学差异，均能较好地完成任务。VDOT的平均每剂量观察时间为16.5 min（标准差[SD] 12.1）， DOT的平均每剂量观察时间为44.1 min（标准差[SD] 3.7）（包括旅行时间），p < 0.01。VDOT组的费用为34.3 (SD 3.8) manmo，与DOT组的71.6 (SD 49.7) manmo相比，差异有统计学意义（p < 0.01）。两组大多数患者认为观察治疗（VDOT/DOT）帮助他们没有错过剂量（185[93.0%]对171 [86.7%],p = 0.057）。与DOT组相比，VDOT组患者有更好的体验。他们认为该方法方便、舒适（191例[96.0%]比111例[56.6%],p < 0.001），必要时选择原方法（191例[96.0%]比113例[57.7%],p < 0.001），并向其他患者推荐该方法（191例[96.0%]比113例[57.7%],p < 0.001）。结论：研究表明，VDOT通过移动设备对结核病患者进行了有意义的直接观察，患者和卫生保健提供者对此高度接受。它还节省了时间，是一种具有成本效益的方法，能够将节省的资金用于其他急需的结核病领域。
Background: Since 1990s, directly observed therapy (DOT) has been the standard-of-care for tuberculosis (TB), although it is cumbersome for patients as well as service providers. For raising implementation, an alternative delivery method with good potential is telehealth. The current study assessed the clinical and cost benefit of video directly observed therapy (VDOT), compared with DOT service. Methods: This prospective randomized controlled trial randomized adults with bacteriologically confirmed pulmonary TB to the intervention (VDOT) or control (DOT) group. The observation data for DOT and VDOT were updated by observers until the end of treatment or until the study concluded. The primary outcome was the TB treatment result defined by the World Health Organization (WHO) as used in some other studies conducted in North India and England as follows: good (cured and treatment completed), poor (death and failure), relocation, and lost to follow-up and others (refused, adverse reaction, not a TB case). Other secondary measures were treatment adherence, patient satisfaction, time and cost spent on DOT or VDOT. Results: On analyzing the results from 405 participants from each study arm, we found very high rates of treatment completion (96.1% with VDOT vs. 94.6% with DOT). The two observed treatment methods had no statistical differences, and all could accomplish their tasks well. Average time per dose observed was 16.5 min (standard deviation [SD] 12.1) for VDOT, while 44.1 min (SD 3.7) for DOT (including travel time), p < 0.01. And the cost incurred on VDOT was 34.3 (SD 3.8) manmo, which was statistically lower compared with 71.6 (SD 49.7) manmo in the DOT group, p < 0.01. Most of the patients in both groups believed that observed treatment (VDOT/DOT) helped them not to miss doses (185 [93.0%] vs. 171 [86.7%], p = 0.057). Patients in the VDOT group had a better experience compared with those in DOT group. They thought the way was convenient and comfortable (191 [96.0%] vs. 111 [56.6%], p < 0.001), would choose the original way if necessary (191 [96.0%] vs. 113 [57.7%], p < 0.001), and would recommend the method to other patients (191 [96.0%] vs. 113 [57.7%], p < 0.001). Conclusion: The study showed that VDOT enabled meaningful direct observation for TB patients through mobile devices, which was highly acceptable to patients and health care providers. It also saved time and is a cost-effective method, enabling the use of the saved money to other much-needed areas for TB.