Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2021 Jan 25;186(Suppl 1):25-31. doi: 10.1093/milmed/usaa300.
Treatment of latent tuberculosis infection (LTBI) decreases risk of progression to active tuberculosis. Traditional treatment regimens required either daily isoniazid for 9 months, with historically poor compliance, or 12-week directly observed therapy (DOT) with isoniazid and rifapentine, with improved compliance but additional challenges of coordinating weekly clinic visits, further complicated if patients must travel a great distance for care.
Our referral area is complicated by congested traffic often resulting in one-way commutes, which can exceed 2 hours. These travel times would be prohibitive for conducting weekly in-clinic DOT. In an effort to improve access to DOT, we implemented TeleMedicine LTBI DOT (vDOT) within a military pediatric infectious diseases clinic. Patients aged 24 months or older diagnosed with LTBI were referred for possible enrollment into our vDOT clinic. All patients without contraindications for receiving isoniazid and/or rifapentine were offered LTBI treatment via weekly vDOT or daily treatment with isoniazid or rifampin. The first visit for vDOT patients was performed in person to discuss treatment options, demonstrate use of TeleMedicine software, and ensure the patient was able to take the medications. Baseline information about patients and travel time to our facility was determined.
To date, 16 patients have completed LTBI therapy using vDOT. Average one-way travel time to our facility for patients was 51 minutes. Actual time spent in most vDOT encounters was less than 10 minutes. Appointments were arranged to take place outside usual school and work hours so patients could complete vDOT with minimal interruptions to daily life, resulting in 100% treatment compliance and completion.
Conducting LTBI DOT using TeleMedicine is a viable and time-saving measure that still allows for high levels of patient compliance and treatment completion while minimizing interruptions to academic and work schedules.
治疗潜伏性结核感染（LTBI）可降低发展为活动性结核的风险。传统的治疗方案需要每天服用异烟肼 9 个月，历史上的依从性较差，或者使用异烟肼和利福平进行 12 周的直接观察治疗（DOT），虽然依从性有所提高，但每周去诊所就诊的协调工作仍然存在挑战，如果患者需要长途跋涉去就医，情况会更加复杂。
我们的转诊区域交通拥堵严重，单程通勤时间往往超过 2 小时。对于每周在诊所进行 DOT，这些通勤时间是不可行的。为了改善 DOT 的可及性，我们在一家军事儿科传染病诊所内实施了远程医疗 LTBI DOT（vDOT）。年龄在 24 个月或以上、被诊断为 LTBI 的患者被转介到我们的 vDOT 诊所，以确定是否符合入组条件。所有没有接受异烟肼和/或利福平治疗禁忌证的患者都可以选择通过每周 vDOT 或每天服用异烟肼或利福平来进行 LTBI 治疗。vDOT 患者的首次就诊是亲自进行的，以讨论治疗方案、演示远程医疗软件的使用方法，并确保患者能够服用药物。确定了患者的基本信息和到我们医院的出行时间。
迄今为止，已有 16 名患者通过 vDOT 完成了 LTBI 治疗。患者到我们医院的单程交通时间平均为 51 分钟。大多数 vDOT 就诊的实际用时不到 10 分钟。预约安排在正常上学和工作时间之外，以便患者在日常生活中最小程度地受到干扰，完成 vDOT，从而实现了 100%的治疗依从性和完成率。
使用远程医疗进行 LTBI DOT 是一种可行且节省时间的措施，它仍然可以实现高水平的患者依从性和治疗完成率，同时最大限度地减少对学业和工作时间表的干扰。
