Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study

Kiberd, James; Stockman, Cynthia; Radhakrishnan, Arun; Phillips, Matthew; Kiberd, Bryce A.; West, Kenneth A.; Soroka, Steven D.; Chan, Christopher T.; Tennankore, Karthik

doi:10.1177/2054358118794415

Cited by 17 publications

(33 citation statements)

References 34 publications

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“…Of these, five were RCTs, 25 –29 while one was a non-RCT. 30 Of the other included studies, six were pre versus post designs 31 –36 and three had no comparison (observational studies with only follow-up measures). 37 –39 Further details on study characteristics are described in Tables 1 to 3.…”

Section: Resultsmentioning

confidence: 99%

eHealth interventions to support patients in delivering and managing peritoneal dialysis at home: A systematic review

et al. 2020

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Peritoneal dialysis (PD) requires patients to develop a variety of self-management skills in order to effectively deliver and manage their dialysis at home. eHealth interventions may provide patients with accessible information to develop the skills and knowledge they require to manage their treatment. This review aims to identify and evaluate ‘active’ eHealth interventions in supporting patients on PD. Six databases were included within the review using the terms Peritoneal Dialysis, eHealth, telemedicine and remote consultation. Studies which explored patients who were delivering PD, an intervention where the main component involved a digital device and required active engagement from patients were included. The primary outcomes examined were identified using the core outcomes recommended by the Standardised Outcomes in Nephrology in Peritoneal Dialysis initiative (PD infection, cardiovascular disease, mortality, PD failure and life participation). Hospitalisation rates were also considered as a primary outcome. Secondary outcomes included quality of life, patient skills, patient knowledge and satisfaction. Using the inclusion criteria, 15 studies (1334 participants) were included in the study. The effectiveness of eHealth interventions was mixed. Due to high heterogeneity, a meta-analysis was not possible, and quality of evidence was low. Risk of bias across the randomised studies was unclear but bias across non-randomised studies was identified as critical. There were no reported adverse effects of eHealth interventions within the included studies. Despite the high interest of eHealth interventions in PD, good quality evidence is needed to explore their effectiveness before a wider application of eHealth interventions.

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Section: Resultsmentioning

confidence: 99%

eHealth interventions to support patients in delivering and managing peritoneal dialysis at home: A systematic review

et al. 2020

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“…This is particularly important given the low quality and low sustainability of some mobile health applications (39)(40)(41) and the varied mobile health readiness of older and less educated patients (23,28,29). Furthermore, the knowledge that most users stop mobile health application usage soon after initial use (42)(43)(44) suggests a need for additional health care professional education and support to help ensure that mobile health communications can lead to significant improvements in patient experience with home dialysis care (11). This study has important limitations and strengths.…”

Section: Discussionmentioning

confidence: 99%

“…In interventional studies, mobile health has demonstrated improvement in patient-reported outcome measures (4), reduced use of health resources (5), and cost savings to health care services (6). In dialysis care, mobile health has been used to assist diet monitoring (7-10), treatment and symptom monitoring (11), and lifestyle management (12)(13)(14). These uses are promising; however, what is not clear is how ready people on dialysis are to use mobile health for their everyday health care.…”

Section: Introductionmentioning

confidence: 99%

The Mobile Health Readiness of People Receiving In-Center Hemodialysis and Home Dialysis

Hussein

Bennett

Pace

et al. 2020

CJASN

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Background and objectivesMobile health is the health care use of mobile devices, such as smartphones. Mobile health readiness is a prerequisite to successful implementation of mobile health programs. The aim of this study was to examine the status and correlates of mobile health readiness among individuals on dialysis.Design, setting, participants, & measurementsA cross-sectional 30-item questionnaire guided by the Khatun mobile health readiness conceptual model was distributed to individuals on dialysis from 21 in-center hemodialysis facilities and 14 home dialysis centers. The survey assessed the availability of devices and the internet, proficiency, and interest in using mobile health.ResultsIn total, 949 patients (632 hemodialysis and 317 home dialysis) completed the survey. Of those, 81% owned smartphones or other internet-capable devices, and 72% reported using the internet. The majority (70%) reported intermediate or advanced mobile health proficiency. The main reasons for using mobile health were appointments (56%), communication with health care personnel (56%), and laboratory results (55%). The main reported concerns with mobile health were privacy and security (18%). Mobile health proficiency was lower in older patients: compared with the 45- to 60-years group, respondents in age groups <45, 61–70, and >70 years had adjusted odds ratios of 5.04 (95% confidence interval, 2.23 to 11.38), 0.39 (95% confidence interval, 0.24 to 0.62), and 0.22 (95% confidence interval, 0.14 to 0.35), respectively. Proficiency was lower in participants with Hispanic/Latinx ethnicity (adjusted odds ratio, 0.49; 95% confidence interval, 0.31 to 0.75) and with less than college education (adjusted odds ratio for “below high school,” 0.09; 95% confidence interval, 0.05 to 0.16 and adjusted odds ratio for “high school only,” 0.26; 95% confidence interval, 0.18 to 0.39). Employment was associated with higher proficiency (adjusted odds ratio, 2.26; 95% confidence interval, 1.18 to 4.32). Although home dialysis was associated with higher proficiency in the unadjusted analyses, we did not observe this association after adjustment for other factors.ConclusionsThe majority of patients on dialysis surveyed were ready for, and proficient in, mobile health.Clinical Trial registry name and registration number: Dialysis mHealth Survey,NCT04177277

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“…Agarwal and Wilkie [ 30 ] noted that the use of telemedicine in PD has challenges as well: patients may perceive the technology as intrusive, worry about data security or miss the direct contact with healthcare providers. Some have reported low voluntary uptake of telehealth [ 26 , 29 ]. The assumption that all patients on home dialysis are automatically ideal candidates for telemedicine due to their use of technology to deliver their treatment may also be premature: a Norwegian group assessed the perceived potential of telemedicine support for a small number of PD and home haemodialysis (HHD) patients [ 11 ] and found that those patients who used machinery to delivery their dialysis, i.e.…”

Section: Dialysismentioning

confidence: 99%

Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology

Stauss

Floyd

Becker

et al. 2020

Clinical Kidney Journal

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The use of telehealth to support, enhance or substitute traditional methods of delivering healthcare is becoming increasingly common in many specialties, such as stroke care, radiology and oncology. There is reason to believe that this approach remains underutilized within nephrology, which is somewhat surprising given the fact that nephrologists have always driven technological change in developing dialysis technology. Despite the obvious benefits that telehealth may provide, robust evidence remains lacking and many of the studies are anecdotal, limited to small numbers or without conclusive proof of benefit. More worryingly, quite a few studies report unexpected obstacles, pitfalls or patient dissatisfaction. However, with increasing global threats such as climate change and infectious disease, a change in approach to delivery of healthcare is needed. The current pandemic with coronavirus disease 2019 (COVID-19) has prompted the renal community to embrace telehealth to an unprecedented extent and at speed. In that sense the pandemic has already served as a disruptor, changed clinical practice and shown immense transformative potential. Here, we provide an update on current evidence and use of telehealth within various areas of nephrology globally, including the fields of dialysis, inpatient care, virtual consultation and patient empowerment. We also provide a brief primer on the use of artificial intelligence in this context and speculate about future implications. We also highlight legal aspects and pitfalls and discuss the ‘digital divide’ as a key concept that healthcare providers need to be mindful of when providing telemedicine-based approaches. Finally, we briefly discuss the immediate use of telenephrology at the onset of the COVID-19 pandemic. We hope to provide clinical nephrologists with an overview of what is currently available, as well as a glimpse into what may be expected in the future.

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Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study

Cited by 17 publications

References 34 publications

eHealth interventions to support patients in delivering and managing peritoneal dialysis at home: A systematic review

eHealth interventions to support patients in delivering and managing peritoneal dialysis at home: A systematic review

The Mobile Health Readiness of People Receiving In-Center Hemodialysis and Home Dialysis

Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology

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