Home run—results of a chronic kidney disease Telemedicine Patient Education Study

Abstract

Background Chronic kidney disease (CKD) incidence is increasing and associated mortality and morbidity are high. Educating patients is effective in delaying progression and establishing optimal renal replacement therapy (RRT). Tele-education/telemedicine (TM) can be an effective tool to provide such education, but there are no available data quantifying its effectiveness. We attempted to establish such evidence correlating the effect of education in patient choices and with the start of actual RRT. We present results from a 3-year pilot study evaluating the effectiveness of comprehensive predialysis education (CPE) through TM for CKD patients compared with a standard care group [face to face (FTF)]. The patient’s ability to choose RRT was the primary endpoint. Methods This was a randomized controlled study providing CPE over three classes at nine sites (one FTF and eight TM). Three assessment tools were utilized to compare groups: CKD knowledge, literacy and quality of life. Results A total of 47.1% of FTF and 52.2% of TM patients reported not having enough information to choose a modality. This decreased by the third visit (FTF 7.4%, TM 13.2%). Home modality choices more than doubled in both groups (FTF 25.8–67.7%, TM 22.2–50.1%). In patients that completed one visit and needed to start RRT, 47% started on a home modality or received a pre-emptive transplant (home hemodialysis 6%, peritoneal dialysis 38%, transplant 3%). Conclusions Results show almost 90% (TM 87%, FTF 95%) of the attendees could choose a modality after education. Home modality choices doubled. Patients were able to make an informed choice regardless of the modality of education.

Technology, Telehealth, and Nephrology: The Time Is Now

“…The Zuni telenephrology clinic delivered pre-ESKD education along with pre-ESKD care to patients living in rural areas (6). Another trial of dialysis modality education via telemedicine revealed remarkable success, where 90% of patients were able to make an informed decision and home modality choices doubled (9). At UAB, during COVID-19, CKD education and dialysis modality classes have been conducted successfully via a virtual format twice a month.…”

A Randomized Controlled Trial to Evaluate and Assess the Effect of Comprehensive Pre-End Stage Kidney Disease Education on Home Dialysis Use in Veterans, Rationale and Design

“…[17][18][19] CKD awareness is assessed by the prior validated instrument by Wright et al [20] Considering this and other similar validated CKD knowledge instruments lack the domains of ESKD knowledge-essential for informed dialysis decision-the team has developed and pilot tested a 29-item ESKD knowledge questionnaire. [21] This questionnaire will be further re ned during the TEACH-VET, and the team will report on its ndings. A full list and timeline of all collected variables are listed in Figure 1 and Table 1.…”

“…Prior studies have shown the advantages of such two-phase approach on comprehension, fears, and home dialysis selection. [26,21] Over last decade, we have tested, re ned and validated this protocol at two geographically distinct universities and a liated VAs within the US to ensure literacy level and cultural relevance for the target patient population. [11,12] For this study, we further pilot-tested the intervention with a local Veteran Engagement Committee made up of a diverse group of 12 Veterans and Veteran caregiver volunteers from Florida.…”

“…Recently, we demonstrated our protocol can be delivered either face-to-face or through telemedicine with equivalent outcomes in terms of con dence in dialysis decision-making and home dialysis selection. [21] To ensure the intervention is standardized and uniform throughout the study, the renal educators are trained by licensed renal providers in the content, and by experienced patient educators in the delivery of the CPE prior to their involvement in the study. Additionally, with the participants' permission, all CPE sessions are recorded for the rst 3 months of the study or after initiation of the new educator, and 10% of randomly selected CPE are recorded throughout the study period.…”

Advancing American Kidney Health

“…There seems to be ample demand for home dialysis if patients are educated about the therapy. Comprehensive predialysis tele-education may increase home dialysis adoption; tele-education can be scaled to size with limited marginal cost (6). In transitional care units, which are emerging across the country, patients are educated during multiple weeks of in-center HD about all dialytic modalities as well as kidney transplantation.…”