One small change: A clinical nurse specialist on how to make Ireland’s health system better

Lorraine Dolan

Clinical nurse specialist in tuberculosis at St James’s Hospital, Dublin

The one small change to the Irish healthcare system that I would like to see is the introduction of video directly observed therapy (VDOT) for people taking daily medication for tuberculosis (TB).

The World Health Organisation recently said that TB was now the second most common killer infectious disease after Covid-19. Rates of infection of this disease, which initially affects the lungs but can spread to the kidneys, brain and spinal cord, increased during the pandemic for the first time in more than a decade. Case numbers are expected to rise further across Europe as thousands of people become displaced as a result of the war in Ukraine. Vulnerable groups such as migrants, prisoners and people living with HIV are the most likely to become infected with TB, which is spread through the air from person to person in poorly ventilated and confined spaces.

The difficulty is that although TB is curable, treatment can take six months to two years.

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So-called directly observed therapy is when a healthcare professional oversees a patient with TB taking each dose of medicine, to encourage patients to complete their treatment. However, this approach requires patients to attend a clinic every day or for a healthcare professional to go to the patient’s home every day.

An easier system would be for the healthcare professional to observe the patient taking his/her medicine via a video call. St James’s Hospital with its Health Innovation Hub is carrying out research to compare this telemedicine approach (using a smartphone app where the patients record themselves taking medication) with overseeing the daily medication in person. Initial data from the study have shown that patients find the telemedicine approach more convenient.

I believe the roll-out of a countrywide digital public health system to use video directly observed therapy would save time and money as well as ensuring that patients with TB complete the necessary course of medicine to get well again.

- As our health system begins to return to normal activity levels following the Covid-19 pandemic, we would like to hear about one change you would like to see in our health system. It can be something simple that annoys you, day in, day out, that is easily fixed, or it can be a small change in practice or attitude that would make life easier for everyone. Email health@irishtimes.com with your suggestion or fill in the form below.