Interview with Christine Chuck Director, Field Operations Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene.
Tuberculosis (TB) is an airborne disease that can affect anyone of any age. TB is spread when someone is around a person sick with active TB for a prolonged and sustained period of time. The New York City Department of Health and Mental Hygiene Bureau of Tuberculosis Control (BTBC) is a government agency whose mission is to prevent the spread of tuberculosis and to eliminate it as a public health problem in New York City.
The Bureau achieves its mission by
1) identifying all individuals with suspected and confirmed TB disease, and ensuring they are on appropriate treatment; and
2) ensuring that high-risk individuals who are infected with TB do not develop the disease.
Directly Observed Therapy (DOT) is the standard of care for the treatment of persons with TB and is one of the interventions credited with controlling the 1990’s epidemic of tuberculosis in NYC. DOT is offered to eligible patients with suspected or confirmed TB.
DOT involves a trained health care worker observing a patient ingest their daily or intermittent doses of anti-TB medications. In DOT, the health care worker and patient agrees on a convenient time and location to meet for the observation. The patient may come to one of our Chest Centers for observation or the health care worker may meet the patient at a home, work site, train station or other mutually agreed upon location. Although DOT is the standard of care for the treatment of TB, patients sometimes refuse DOT because of scheduling conflicts with work and school, privacy concerns, or inconvenience. Furthermore, DOT is extremely resource intensive requiring a trained staff to provide the DOT, as well as hours of staff travel time for DOT observations in the community.
A patient connects with an observer over Fuze, showing the name of the medication he is getting ready to ingest.
The use of video technology for this therapy - video DOT (VDOT) - aims to remove the aforementioned barriers for both patients and for our program. It removes many scheduling conflicts and is less intrusive for patients. It also cuts down on staff travel time, allowing more patients to be enrolled and observed in a given day by each health care worker.
Why did the Department choose Fuze?
In 2013, we partnered with the University of California San Diego (UCSD) to pilot VDOT in our agency to observe patients on treatment for TB. The Fuze application was provided by our partners at UCSD, and it was chosen because it met the security and privacy criteria of our agency.
How do you use Fuze today?
When the patient agrees to be on VDOT, they are provided with a smart phone with the Fuze application already installed. They are trained on how to use the phone and the Fuze application. The Fuze application is also installed on a secure computer used by the health care worker doing the observation.
The patient connects with the health care worker at the scheduled time through the Fuze application. Through live video interaction the health care worker asks how the patient is doing, if they are experiencing any side effects from the medication and then the health care worker observes the patient taking their medication. This generally takes about 5 minutes, and allows the health care worker and the patient to perform face to face DOT from the convenience of their preferred locations without the need for the health care worker to visit the patient in their individual location.
Through Fuze, the health care worker observes the patient taking medication and ensures there are no immediate side effects.
How is Fuze making an impact in the treatment of tuberculosis?
Fuze allows us to securely provide VDOT to our patients where ever they are in the country provided there is culler/internet service therefore giving the patient mobility and privacy. Patients on VDOT are no longer required to wait in any one location for the observer’s arrival they can connect with the healthcare worker from any location at the scheduled time.
Fuze is easy to install on the phones, and both staff and patients can easily be trained on the application.
Because Fuze travels with the patient, patients who travel for their jobs, or even on vacation, can remain compliant with treatment. In addition, our healthcare workers save time, and can complete additional case management services or TB prevention activities in the time saved from traveling. Fuze has also been reliable, resulting in minimal technological problems.
To learn more about the applications of Fuze, check out our Use Case Catalog.