1. VIDEO DOT

2. San Diego County began a Video DOT program in March 2004 as an adjunct to the existing in-person DOT program. The Video DOT program was fully operational during 2005. Original Video DOT Phone

3.  222 cases reported in 2010.  County of San Diego covers 4,200 square miles.  Over 3 million people live in the County.  8 TB-Dedicated PHN Case Managers.  8 Outreach Workers – In-person DOT.

4. Video DOT is observed and documented centrally by trained TB Control Program staff Monday through Friday from 6:30 a.m. to 5:00 p.m. Staff needed to operate the program include: Video DOT Coordinator DOT Staff Public Health Nurse

5.  DOT staff calls each patient at a prearranged time.  Inquires about possible side effects.  Watches patient take medication.  Confirms next DOT time. HOW IT WORKS Patient receiving DOT Nurse conducting Video DOT

6.  DOT records, weekly DOT schedule and videophone.  DOT worker documents medications taken. HOW IT WORKS  Provides pertinent feedback to PHN Case Manager.

7. Patient’s are asked to sign a consent form explaining DOT procedures. The DOT face sheet ensures that pertinent information is attached to each individuals DOT record.

8. Outcomes Patients enjoy the flexibility. Staff have adapted to the process. Essentially all patients complete treatment. Since its introduction in 2004, 20 patients are on Video DOT at any given time.

9.  Cost savings from 2006 analysis:  23,458 miles @ $0.445 = $10,439  663 hours in travel time @ $22.60/hour = $14,984

10.  Technology glitches  Landlines: Digital vs. Analog  Picture quality  Adequate lighting

11.  The Video DOT program has become an integral part of the TB Control Program.  Video DOT staff handled an average caseload slightly larger than that of a fulltime Outreach Worker. Recorded Video DOT Principal Investigator : Richard Garfein, UCSD School of Medicine Improvements have been made in technology