Evaluation of National Video Directly Observed Therapy Implementation

全国视频直视治疗实施情况评价

基本信息

批准号：
9556923
负责人：
MAUNANK SHAH
金额：
$ 49.96万
依托单位：
EMOCHA MOBILE HEALTH, INC.
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-25 至 2020-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9556923
关键词：
Adherence Adoption Adverse effects Architecture Caring Cause of Death Clinic Commercial Sectors Data Devices Directly Observed Therapy Effectiveness Ensure Evaluation Geography Goals Health Insurance Portability and Accountability Act Health Personnel Health Priorities Ingestion Internet Investments Knowledge Logistics Maintenance Methods Minority Monitor Patients Persons Pharmaceutical Preparations Phase Pilot Projects Population Privacy Private Sector Privatization Procedures Process Provider Public Health Public Sector Regimen Reporting Research Infrastructure Research Personnel Self-Administered Site Small Business Innovation Research Grant Standardization Structure System Technology Tuberculosis Update Visit Visual authority cost cost effective demographics economic evaluation effective intervention experience implementation research implementation science improved interest isoniazid mHealth medication compliance member mobile application patient oriented patient population prevent programs provider networks public health intervention rifapentine scale up social stigma standard of care success treatment adherence treatment duration tuberculosis treatment uptake usability user-friendly web portal

项目摘要

PROJECT SUMMARY emocha Mobile Health, Inc and Johns Hopkins investigators have developed a user-friendly, HIPAA compliant application for asynchronous video directly observed therapy (DOT) – miDOT. The miDOT platform consists of a patient-facing mobile application where patients can record videos of themselves taking medication at their convenience and a provider-facing web portal that allows providers to monitor adherence and progress, visualize data, generate reports, view side effects reports, and automatically send SMS medication reminders. The platform represents a patient-centered strategy for improving adherence support and overcomes cost and logistical barriers to traditional DOT while maintaining patient autonomy and respect. Our SBIR Phase I efforts successfully demonstrated: 1) technological feasibility of using miDOT for TB treatment monitoring 2) miDOT is acceptable and preferred by patients and providers for TB treatment and 3) miDOT is effective at ensuring high levels of adherence and treatment completion. However, several key knowledge deficits exist. First, our Phase I efforts focused on patients with prior demonstration of good adherence in one state. It is now imperative to demonstrate that miDOT would be used and effective in a broader patient population. Second, current video-DOT efforts have focused on active TB patients;; however, public health authorities have also prioritized treatment for the estimated 13 million people in the US living with latent TB infection (LTBI). A short course regimen for LTBI is recommended to prevent progression to active TB, and consists of 3 months of weekly isoniazid (INH) and rifapentine – or 3HP - administered under DOT;; however, uptake has been limited due to this DOT requirement, which is not logistically feasible with such high patient volumes. Alternative self-administered LTBI treatments can be prescribed, but are lengthy (4-9 months) and have poor completion rates. Finally, there is a need to define best practices for miDOT integration and adoption into current TB programs. Our SBIR Phase II goal is to guide programmatic scale-up through implementation research while building the necessary technical infrastructure to allow the system scale commercially to meet the needs of larger patient populations.

项目概要 emocha Mobile Health, Inc 和约翰霍普金斯大学的研究人员开发了一种用户友好的、符合 HIPAA 要求的异步视频直接观察治疗 (DOT) 应用程序 – miDOT。 miDOT 平台由面向患者的移动应用程序组成，患者可以在其中进行记录。自己在方便时服用药物的视频以及面向提供者的门户网站允许提供商监控遵守情况和进度、可视化数据、生成报告、查看副作用报告，并自动发送短信用药提醒平台。代表了一种以患者为中心的策略，用于改善依从性支持并克服成本以及传统 DOT 的后勤障碍，同时保持患者的自主权和尊重。我们的 SBIR 第一阶段努力成功证明了：1) 使用 miDOT 的技术可行性用于结核病治疗监测 2) miDOT 是患者和提供者可接受并首选的结核病治疗和 3) miDOT 可有效确保高水平的依从性和治疗。然而，存在一些关键的知识缺陷，首先，我们第一阶段的工作重点是。先前在某种状态下表现出良好依从性的患者。现在必须证明 miDOT 将在更广泛的患者群体中使用并有效。当前的视频 DOT 工作重点是活动性结核病患者；但是，公共卫生当局还优先治疗美国约 1300 万潜伏性结核病患者建议采用短疗程治疗 LTBI，以防止进展为 LTBI。活动性结核病，包括 3 个月每周一次的异烟肼 (INH) 和利福喷汀 – 或 3HP – 根据 DOT 管理；但是，由于 DOT 的这一要求，吸收受到限制对于如此大量的患者，替代性自我管理的 LTBI 在逻辑上是不可行的。可以处方治疗，但治疗时间较长（4-9 个月）且完成率较低。最后，需要定义 miDOT 集成和采用到当前的最佳实践我们的 SBIR 第二阶段目标是通过指导计划扩大规模。实施研究，同时建立必要的技术基础设施，使系统可进行商业扩展，以满足更多患者群体的需求。