Abstract:Peritoneal teledialysis (telePD) is a modembased communication link between the patients' cyclers and a computer in the dialysis unit that allows the transmission and storage of a series of automated peritoneal dialysis (APD) treatment data. In order to evaluate the usefulness of telePD in quantifying the problems that may occur during pediatric APD, we retrospectively studied four patients with a median age of 14.1±1.8 years during their initial months of telePD. The selection criteria were potential non-comp… Show more
“…Of the few studies in the literature exploring the use of RM for PD, most report findings similar to ours [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. For instance, Gallar et al [ 15 ] reported reduced clinical examination time for PD patients using home videoconferencing equipment compared with hospital consultation (22 vs. 33 minutes, p < 0.05), and reduced hospitalization rates (2.2 vs. 5.7 days/patient/year, p < 0.05).…”
Aims: Remote monitoring (RM) can improve management of chronic diseases. We evaluated the impact of RM in automated peritoneal dialysis (APD) in a simulation study. Materials and methods: We simulated 12 patient scenarios with common clinical problems and estimated the likely healthcare resource consumption with and without the availability of RM (RM+ and RM– groups, respectively). Scenarios were evaluated 4 times by randomly allocated nephrologist-nurse teams or nephrologist-alone assessors. Results: The RM+ group was assessed as having significantly lower total healthcare resource consumption compared with the RM– group (36.8 vs. 107.5 total episodes of resource consumption, p = 0.002). The RM+ group showed significantly lower “unplanned hospital visits” (2.3 vs. 11.3, p = 0.005), “emergency room visits” (0.5 vs. 5.3, p = 0.003), “home visits” (0.5 vs. 5.8, p = 0.016), “exchanges over the telephone” (18.5 vs. 57.8, p = 0.002), and “change to hemodialysis” (0.5 vs. 2.5, p = 0.003). Evaluations did not differ between nephrologist-nurse teams vs. nephrologist-alone assessors. Conclusion: RM can be expected to reduce healthcare resource consumption in APD patients.
“…Of the few studies in the literature exploring the use of RM for PD, most report findings similar to ours [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. For instance, Gallar et al [ 15 ] reported reduced clinical examination time for PD patients using home videoconferencing equipment compared with hospital consultation (22 vs. 33 minutes, p < 0.05), and reduced hospitalization rates (2.2 vs. 5.7 days/patient/year, p < 0.05).…”
Aims: Remote monitoring (RM) can improve management of chronic diseases. We evaluated the impact of RM in automated peritoneal dialysis (APD) in a simulation study. Materials and methods: We simulated 12 patient scenarios with common clinical problems and estimated the likely healthcare resource consumption with and without the availability of RM (RM+ and RM– groups, respectively). Scenarios were evaluated 4 times by randomly allocated nephrologist-nurse teams or nephrologist-alone assessors. Results: The RM+ group was assessed as having significantly lower total healthcare resource consumption compared with the RM– group (36.8 vs. 107.5 total episodes of resource consumption, p = 0.002). The RM+ group showed significantly lower “unplanned hospital visits” (2.3 vs. 11.3, p = 0.005), “emergency room visits” (0.5 vs. 5.3, p = 0.003), “home visits” (0.5 vs. 5.8, p = 0.016), “exchanges over the telephone” (18.5 vs. 57.8, p = 0.002), and “change to hemodialysis” (0.5 vs. 2.5, p = 0.003). Evaluations did not differ between nephrologist-nurse teams vs. nephrologist-alone assessors. Conclusion: RM can be expected to reduce healthcare resource consumption in APD patients.
“…At present, several small observational studies on RPM in dialysis patients suggest the technical feasibility and numerous potential benefits of RPM. 18 , 25 , 26 , 27 , 28 However, many potential opportunities identified by the consensus panel have yet to be explored ( Figure 1 ). Figure 1 Opportunities for remote patient management.…”
Remote patient management (RPM) offers renal health care providers and patients with end-stage kidney disease opportunities to embrace home dialysis therapies with greater confidence and the potential to obtain better clinical outcomes. Barriers and evidence required to increase adoption of RPM by the nephrology community need to be clearly defined. Ten health care providers from specialties including nephrology, cardiology, pediatrics, epidemiology, nursing, and health informatics with experience in home dialysis and the use of RPM systems gathered in Vienna, Austria to discuss opportunities for, barriers to, and system requirements of RPM as it applies to the home dialysis patient. Although improved outcomes and cost-effectiveness of RPM have been demonstrated in patients with diabetes mellitus and heart disease, only observational data on RPM have been gathered in patients on dialysis. The current review focused on RPM systems currently in use, on how RPM should be integrated into future care, and on the evidence needed for optimized implementation to improve clinical and economic outcomes. Randomized controlled trials and/or large observational studies could inform the most effective and economical use of RPM in home dialysis. These studies are needed to establish the value of existing and/or future RPM models among patients, policy makers, and health care providers.
“…Many of these benefits, although intuitive, are currently hypothetic and few clinical studies (Table 2 lists clinical studies in this area) have demonstrated specific benefits of telehealth services for patients with ESRD. The current literature in this are single center experiences utilizing telemedicine for the care of patients receiving HD (14-23) or PD (24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Thus, studies that address the utility of telehealth and include endpoints of interest to patients, providers, and payers (i.e., improvements in mortality, lowering of readmission rates, improved quality of life, and cost savings) are needed.…”
Section: Opportunities For the Care Of Patients With Esrdmentioning
confidence: 99%
“…Through the provision of a suite of telehealth services, patient satisfaction may increase with home therapies. Although small studies support the idea that patient satisfaction with telemedicine care for patients with ESRD will be high, further studies are needed in this domain (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). There are potential downsides to telemedicine in terms of perceived intrusion into privacy and depersonalization that will also need to be investigated.…”
Telehealth and remote monitoring of a patient's health status has become more commonplace in the last decade and has been applied to conditions such as heart failure, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease. Conversely, uptake of these technologies to help engender and support home RRTs has lagged. Although studies have looked at the role of telehealth in RRT, they are small and single-centered, and both outcome and cost-effectiveness data are needed to inform future decision making. Furthermore, alignment of payer and government (federal and state) regulations with telehealth procedures is needed along with a better understanding of the viewpoints of the various stakeholders in this process (patients, caregivers, clinicians, payers, dialysis organizations, and government regulators). Despite these barriers, telehealth has great potential to increase the acceptance of home dialysis, and improve outcomes and patient satisfaction while potentially decreasing costs. The Kidney Health Initiative convened a multidisciplinary workgroup to examine the current state of telehealth use in home RRTs as well as outline potential benefits and drawbacks, impediments to implementation, and key unanswered questions.
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