Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study

Jeffs, Lianne; Jamieson, Trevor; Saragosa, Marianne; Mukerji, Geetha; Jain, Arsh K.; Man, Rachel; Desveaux, Laura; Shaw, James; Agarwal, Payal; Hensel, Jennifer; Onabajo, Nike; Nguyen, Megan; Bhatia, R Sacha

doi:10.2196/humanfactors.9720

Cited by 4 publications

(2 citation statements)

References 43 publications

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“…Moreover, by using remote supervision and monitoring, the team can maintain close contact and guide patients and caregivers until a proper solution is found. Incidentally, remote patient monitoring systems are already available for automated PD cyclers, and the COVID-19 pandemic has accelerated the transition to virtual care [18][19][20].…”

Section: Lessons Learnt During the Covid-19 Pandemicmentioning

confidence: 99%

Lessons Learnt during the COVID-19 Pandemic: For Patients with End-Stage Renal Disease, We Should Prioritize Home-Based Treatment and Telemedicine

Brunori

Reboldi

Aucella

2021

Kidney Blood Press Res

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Backgrounds: The recent coronavirus disease 2019 (COVID-19) pandemic has placed worldwide health systems and hospitals under pressure, and so are the renal care models. This may be a unique opportunity to promote and expand alternative models of health-care delivery in patients undergoing renal replacement therapies. Summary: Despite the high risk of acquiring communicable diseases when undergoing in-centre treatments, only a small proportion of patients are currently being treated with home therapies. Recent data provided by the Italian Society of Nephrology (SIN), the REIN French Registry and the Wuhan Hemodialysis Quality Control Center clearly show that patients receiving hospital-based treatment have a 3- to 4-fold greater risk of infection, and a subsequent fatality proportion between 21 and 34%. On the other hand, home-based therapy can be managed remotely, there is little or no need for transport to and from the hospital, and it is less expensive. Besides, the digital revolution in health care with the development of virtual care systems can make home dialysis with telehealth a cost-effective solution for both patients and health-care providers. Such a transition would require specific training for physicians and health-care professionals and a functional re-organization of dialysis centres to improve the skills and expertise in caring for patients at home. Conclusion: The need for more widespread home treatment is the main lesson learnt by nephrologists by the COVID-19 pandemic.

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Section: Lessons Learnt During the Covid-19 Pandemicmentioning

confidence: 99%

Lessons Learnt during the COVID-19 Pandemic: For Patients with End-Stage Renal Disease, We Should Prioritize Home-Based Treatment and Telemedicine

Brunori

Reboldi

Aucella

2021

Kidney Blood Press Res

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“…All PD physicians are required to help patients not only with removing uremic toxin but also controlling the volume status to improve patient outcomes [16][17][18]. We created an app as a reference to quickly and objectively determine the optimal DV for PD patients in conforming and safety zones.…”

Section: What This Knowledge Adds To What We Already Knewmentioning

confidence: 99%

An App Predicting Peritoneal Dialysis Appropriate Dwell Volume for Patients in Daily Quality-of-Care Practice

Chien

Wang

Chien

2020

Preprint

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Background Few studies mention how to objectively adjust peritoneal dialysis (PD) dwell volume (DV) for adult continuous ambulatory peritoneal dialysis patients. It requires a great deal of physicians’ precious time to determine the appropriate DV during daily practice. An app with evidence is required to solve this problem independently and efficiently This study aims to determine a method for fluid control that can reduce fluid overload-related complications. We proposed a reference equation composed of parameters from the peritoneal equilibration test (PET) for adjusting daily dialysate DV to obtain more ultrafiltration volume.Methods Ninety PD patients being treated at one medical center were enrolled, with laboratory data collected during half-yearly PET evaluations. The instilled dialysate was composed of 2.57% glucose PD fluid, either 1500 ml or 2000 ml for two groups in DV. We measured intraperitoneal pressure (IPP) before dialysate instilled (P0) and drained in the supine position after four hours (P4), effluent volume (ml), body mass index (BMI), waist circumference, and other parameters, including social demographics, to predict the appropriate DV. Exploratory factor analysis (EFA) was performed to extract independent domains. Statistical multivariate techniques of discrimination analysis and logistic regression (LR) to verify the most feasible and optimal formula were applied to determine inflow volumes for patients. A final equation for fine-tuning daily DV was proposed with an app to be used for physicians and patients in clinical settings.Results Two domains were observed by using EFA: (1) P0, and P4, and effluent volume and (2) BMI and waist circumference. We determined a formula for calculating daily dialysate DV, derived from Logistic analysis to obtain an accurate prediction rate of 94.44% with Z = 4.32974 + 3.85477 * F1 + 3.83008 * F2, higher than the previous study at 80.68%. An app was created to easily adjust the DV in the daily procedure.Conclusion The novel formula, combined with an app using objective, real-time parameters for predicting appropriate DVs, was proposed for PD patients to optimize maximal ultrafiltration volumes and reduce subjective abdominal discomfort. DV is easy to calculate using the app, which makes it possible for physicians or patients to make frequent adjustments.

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Approaches to Spread, Scale-Up, and Sustainability

Papoutsi,

Greenhalgh,

Marjanovic

2024

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Few interventions that succeed in improving healthcare locally end up becoming spread and sustained more widely. This indicates that we need to think differently about spreading improvements in practice. Drawing on a focused review of academic and grey literature, the authors outline how spread, scale-up, and sustainability have been defined and operationalised, highlighting areas of ambiguity and contention. Following an overview of relevant frameworks and models, they focus on three specific approaches and unpack their theoretical assumptions and practical implications: the Dynamic Sustainability Framework, the 3S (structure, strategy, supports) infrastructure approach for scale-up, and the NASSS (non-adoption, abandonment, and challenges to scale-up, spread, and sustainability) framework. Key points are illustrated through empirical case narratives and the Element concludes with actionable learning for those engaged in improvement activities and for researchers. This title is also available as Open Access on Cambridge Core.

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Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study

Cited by 4 publications

References 43 publications

Lessons Learnt during the COVID-19 Pandemic: For Patients with End-Stage Renal Disease, We Should Prioritize Home-Based Treatment and Telemedicine

Lessons Learnt during the COVID-19 Pandemic: For Patients with End-Stage Renal Disease, We Should Prioritize Home-Based Treatment and Telemedicine

An App Predicting Peritoneal Dialysis Appropriate Dwell Volume for Patients in Daily Quality-of-Care Practice

Approaches to Spread, Scale-Up, and Sustainability

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