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Tum P, Awan F, Baharani J, Coyne E, Dreyer G, Ewart C, Kalebe-Nyamomgo C, Mitra U, Wilkie M, Thomas N. Getting the most out of remote care: Co-developing a Toolkit to improve the delivery of remote kidney care appointments for underserved groups. J Ren Care 2024. [PMID: 38837674 DOI: 10.1111/jorc.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/08/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Telephone and video appointments are still common post-pandemic, with an estimated 25%-50% of kidney appointments in the United Kingdom still conducted remotely. This is important as remote consultations may exacerbate pre-existing inequalities in those from underserved groups. Those from underserved groups are often not represented in health research and include those with learning disability, mental health needs, hearing/sight problems, young/older people, those from ethnic minority groups. OBJECTIVES The aim was to develop a Toolkit to improve the quality of remote kidney care appointments for people from different underserved groups. DESIGN A parallel mixed methods approach with semistructured interviews/focus groups and survey. We also conducted workshops to develop and validate the Toolkit. PARTICIPANTS Seventy-five renal staff members completed the survey and 21 patients participated in the interviews and focus groups. Patients (n = 11) and staff (n = 10) took part in the Toolkit development workshop, and patients (n = 13) took part in the Toolkit validation workshop. RESULTS Four themes from interviews/focus groups suggested areas in which remote appointments could be improved. Themes were quality of appointment, patient empowerment, patient-practitioner relationship and unique needs for underserved groups. Staff reported difficulty building rapport, confidentiality issues, confidence about diagnosis/advice given, technical difficulties and shared decision making. CONCLUSION This study is the first to explore experiences of remote appointments among both staff and those from underserved groups living with kidney disease in the United Kingdom. While remote appointments can be beneficial, our findings indicate that remote consultations need optimisation to meet the needs of patients. The project findings informed the development of a Toolkit which will be widely promoted and accessible in the United Kingdom during 2024.
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Affiliation(s)
- Patricia Tum
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Fez Awan
- Renal Patient Led Advisory Network (R-PLAN), Blackburn, UK
| | - Jyoti Baharani
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Coyne
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Catriona Ewart
- Institute of Health and Social Care, London South Bank University, London, UK
| | | | - Udita Mitra
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicola Thomas
- Institute of Health and Social Care, London South Bank University, London, UK
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Starr MC, Altemose K, Parsley J, Cater DT, Hains DS, Soranno DE. Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy. Pediatr Nephrol 2024; 39:325-329. [PMID: 37310496 DOI: 10.1007/s00467-023-06036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, some continuous kidney replacement therapy (CKRT) initiations were transitioned to telemedicine to improve the timeliness of initiation, and minimize COVID-19 transmission. While telemedicine would appear acceptable for many clinical settings, safety and timeliness of telemedicine CKRT initiation is undescribed. METHODS We conducted a single-center retrospective cohort study of pediatric patients on CKRT from January 2021-September 2022. Information on patient characteristics and CKRT therapy was extracted from the electronic health record. Multidisciplinary team provider attitudes and perspectives were assessed using survey. RESULTS During the study period, there were 101 CKRT circuit initiations in patients not previously receiving CKRT, with 33% (33/101) initiated by telemedicine. There were no differences in patient characteristics, including age, weight at initiation, severity of illness, nor degree of fluid overload between the in-person and telemedicine initiation cohorts. CKRT telemedicine initiations were timelier, occurring on average 3.0 h after decision to initiate therapy compared to 5.8 h for all in-person CKRT starts (p < 0.001) and 5.5 h for night and weekend in-person starts (p < 0.001). Complications did not differ between telemedicine and in-person starts (15% vs. 15%, p = 0.99) and initial circuit life was similar. There were no differences in likelihood of death or duration of CKRT therapy. Telemedicine initiations were widely acceptable to multidisciplinary providers. CONCLUSION In appropriately selected patients, telemedicine initiation of CKRT is a timely and safe option. Further standardization of telemedicine initiation of CKRT should be considered to improve the timely delivery of CKRT and may improve nephrology workforce wellness. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Michelle C Starr
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA.
| | - Kathleen Altemose
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessalynn Parsley
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel T Cater
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David S Hains
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle E Soranno
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Bioengineering, Purdue University, West Lafayette, IN, USA
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journal club. Kidney Int 2023. [DOI: 10.1016/j.kint.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Clark SL, Begin B, De Souza HG, Mallett K, Hanna MG, Richardson T, Esporas M, Bowie A, Taylor K, Reyes LC, Hughey M, Neu A, Warady BA. Telehealth survey of providers and caregivers of children on peritoneal dialysis during the COVID-19 pandemic. Pediatr Nephrol 2023; 38:203-210. [PMID: 35425999 PMCID: PMC9010071 DOI: 10.1007/s00467-022-05543-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND There has been growing support for the adoption of telehealth (TH) services in pediatric populations. Children on chronic peritoneal dialysis (PD) represent a vulnerable population that could benefit from increased use of TH. The COVID-19 pandemic prompted rapid adoption of TH services in the population among pediatric centers participating in The Children's Hospital Association's Standardizing Care to Improve Outcomes in Pediatric ESKD (SCOPE) Collaborative. METHODS We developed a survey to explore the experience of both pediatric PD providers and caregivers of patients receiving PD care at home and using TH services during the COVID-19 pandemic. RESULTS We obtained responses from 27 out of 53 (50.9%) SCOPE centers that included 175 completed surveys from providers and caregivers. Major challenges identified by providers included inadequate/lack of physical exam, inability to visit with the patient/family in-person, and inadequate/lack of PD catheter exit site exam. Only 51% of caregivers desired future TH visits; however, major benefits of TH for caregivers included no travel, visit takes less time, easier to care for other children, more comfortable for patient, and no time off from work. Providers and caregivers agreed that PD TH visits are family centered (p = 0.296), with the lack of a physical exam (p < 0.001) and the inability to meet in-person (p = 0.002) deemed particularly important to caregivers and providers, respectively. CONCLUSIONS TH is a productive and viable visit option for children on PD; however, making this a successful, permanent part of routine care will require an individualized approach with standardization of core elements. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Stephanie L. Clark
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Brandy Begin
- Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
| | | | | | - Melisha G. Hanna
- Children’s Hospital Colorado, Department of Pediatrics, Division of Nephrology, University of Colorado, Aurora, CO USA
| | - Troy Richardson
- Children’s Hospital Association, Washington D.C. and Lenexa, KS USA
| | - Megan Esporas
- Children’s Hospital Association, Washington D.C. and Lenexa, KS USA
| | | | - Karri Taylor
- Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
| | | | | | - Alicia Neu
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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George K, Subbiah A, Yadav RK, Bagchi S, Mahajan S, Bhowmik D, Agarwal SK. Utility and patient acceptance of telemedicine in nephrology. J Nephrol 2022; 35:2325-2331. [PMID: 36367662 PMCID: PMC9651110 DOI: 10.1007/s40620-022-01471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE There is an increasing burden of kidney diseases worldwide and access to specialist care is limited. Telemedicine, has been relatively less used in developing countries like India. The current study aims to assess the feasibility and acceptance of telenephrology services at our institute, a public hospital. METHODS A total of 150 patients were selected by stratified random sampling from the list of attendees who had undergone both in-person outpatient consultation and telenephrology consultation. Patient's attitude towards, and knowledge and acceptance of telenephrology services were evaluated. RESULTS The average age of the study cohort was 42.52 ± 15.1 years. More than one-third (39.3%) of our patients belonged to the lower middle socioeconomic class. The median distance traveled to reach our outpatient clinic was 113.5 km (3-2249 km). Patients reported lost workdays in 54.7% cases. The majority (95%) of patients managed to consult through teleservices successfully. Ninety percent of the patients gave a satisfaction score of 4 (out of 5) or above for their tele-consultation experience. The most important perceived benefit of teleconsultation was the reduced risk of infection (40.6%) followed by economic benefits (32%). The major disadvantage (36%) was the absence of physical examination. A combination of physical and telenephrology services was the option preferred by 84% of the patients. CONCLUSION In developing countries like India, with the majority of the population residing outside major cities and with limited medical access, telenephrology has a huge potential to provide quality nephrology care to the remotest parts of the country.
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Affiliation(s)
- Kristin George
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Arunkumar Subbiah
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Raj Kanwar Yadav
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Soumita Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Dipankar Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India
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journal club. Kidney Int 2022. [DOI: 10.1016/j.kint.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Ewart C, Baharani J, Wilkie M, Thomas N. Patient perspectives and experiences of remote consultations in people receiving kidney care: A scoping review. J Ren Care 2022; 48:143-153. [PMID: 35338610 PMCID: PMC9545432 DOI: 10.1111/jorc.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in a rapid and sometimes chaotic change in how clinical care was delivered for people living with kidney disease, with increased reliance on digital technologies and the introduction of remote services. OBJECTIVES To conduct a scoping review of studies about patients' experiences and perspectives in receipt of remote consultations for kidney care. DESIGN Using Arksey and O'Malley's framework, three databases were searched on EBSCO (CINAHL, MEDLINE and Psych INFO). The search included studies published in English from August 2010 to August 2021. RESULTS Eight studies met the scoping review criteria (two cross-sectional, two mixed-method and four qualitative). Five themes were identified: overall satisfaction with remote services, benefits to patients (convenience, involvement in care and patient safety), barriers to remote consultations (technical difficulties, digital literacy and loss of interpersonal communication), patient concerns (need for physical examination, privacy and confidentiality) and prerequisites for successful remote care (existing patient-practitioner relationship, stable illness phase and access to technology). CONCLUSION Remote consultations confer multiple advantages to patients; therefore, remote consultations should be offered as an option to patients living with kidney disease beyond the COVID-19 pandemic. However, there are several barriers to remote consultation that need to be addressed and understood before implementing remote care long-term. Future research should examine the impact of remote consultations on people living with kidney disease from under-served groups to identify barriers and ensure their suitability and accessibility to the wider population for a more patient-centred approach to kidney care.
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Affiliation(s)
- Catriona Ewart
- Institute of Health and Social Care, London South Bank University, London, UK
| | | | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Nicola Thomas
- Institute of Health and Social Care, London South Bank University, London, UK
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Scholes-Robertson NJ, Gutman T, Howell M, Craig J, Chalmers R, Dwyer KM, Jose M, Roberts I, Tong A. Clinicians' perspectives on equity of access to dialysis and kidney transplantation for rural people in Australia: a semistructured interview study. BMJ Open 2022; 12:e052315. [PMID: 35177446 PMCID: PMC8860044 DOI: 10.1136/bmjopen-2021-052315] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES People with chronic kidney disease requiring dialysis or kidney transplantation in rural areas have worse outcomes, including an increased risk of hospitalisation and mortality and encounter many barriers to accessing kidney replacement therapy. We aim to describe clinicians' perspectives of equity of access to dialysis and kidney transplantation in rural areas. DESIGN Qualitative study with semistructured interviews. SETTING AND PARTICIPANTS Twenty eight nephrologists, nurses and social workers from 19 centres across seven states in Australia. RESULTS We identified five themes: the tyranny of distance (with subthemes of overwhelming burden of travel, minimising relocation distress, limited transportation options and concerns for patient safety on the roads); supporting navigation of health systems (reliance on local champions, variability of health literacy, providing flexible models of care and frustrated by gatekeepers); disrupted care (without continuity of care, scarcity of specialist services and fluctuating capacity for dialysis); pervasive financial distress (crippling out of pocket expenditure and widespread socioeconomic disadvantage) and understanding local variability (lacking availability of safe and sustainable resources for dialysis, sensitivity to local needs and dependence on social support). CONCLUSIONS Clinicians identified geographical barriers, dislocation from homes and financial hardship to be major challenges for patients in accessing kidney replacement therapy. Strategies such as telehealth, outreach services, increased service provision and patient navigators were suggested to improve access.
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Affiliation(s)
- Nicole Jane Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Rachel Chalmers
- Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
| | - Karen M Dwyer
- School of Medicine, Faculty of Health, Deakin University-Geelong Campus at Waurn Ponds, Geelong, Victoria, Australia
| | - Matthew Jose
- Hobart Clinical School, University of Tasmania School of Medicine, Hobart, Tasmania, Australia
- Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Ieyesha Roberts
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Journal Club. Kidney Int 2022. [DOI: 10.1016/j.kint.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Journal club. Kidney Int 2021. [DOI: 10.1016/j.kint.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Huuskes BM, Scholes‐Robertson N, Guha C, Baumgart A, Wong G, Kanellis J, Chadban S, Barraclough KA, Viecelli AK, Hawley CM, Kerr PG, Toby Coates P, Amir N, Tong A. Kidney transplant recipient perspectives on telehealth during the COVID-19 pandemic. Transpl Int 2021; 34:1517-1529. [PMID: 34115918 PMCID: PMC8420311 DOI: 10.1111/tri.13934] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/09/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has challenged the delivery of health services. Telehealth allows delivery of care without in-person contacts and minimizes the risk of vial transmission. We aimed to describe the perspectives of kidney transplant recipients on the benefits, challenges, and risks of telehealth. We conducted five online focus groups with 34 kidney transplant recipients who had experienced a telehealth appointment. Transcripts were thematically analyzed. We identified five themes: minimizing burden (convenient and easy, efficiency of appointments, reducing exposure to risk, limiting work disruptions, and alleviating financial burden); attuning to individual context (depending on stability of health, respect patient choice of care, and ensuring a conducive environment); protecting personal connection and trust (requires established rapport with clinicians, hampering honest conversations, diminished attentiveness without incidental interactions, reassurance of follow-up, and missed opportunity to share lived experience); empowerment and readiness (increased responsibility for self-management, confidence in physical assessment, mental preparedness, and forced independence); navigating technical challenges (interrupted communication, new and daunting technologies, and cognizant of patient digital literacy). Telehealth is convenient and minimizes time, financial, and overall treatment burden. Telehealth should ideally be available after the pandemic, be provided by a trusted nephrologist and supported with resources to help patients prepare for appointments.
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Affiliation(s)
- Brooke M Huuskes
- Department of Physiology, Anatomy and MicrobiologyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Nicole Scholes‐Robertson
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Chandana Guha
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Amanda Baumgart
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Germaine Wong
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
- Centre for Transplant and Renal ResearchWestmead HospitalSydneyNew South WalesAustralia
| | - John Kanellis
- Department of MedicineMonash UniversityClaytonVictoriaAustralia
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
| | - Steve Chadban
- Department of Renal MedicineRoyal Prince Alfred HospitalCentral Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | | | - Andrea K Viecelli
- Department of NephrologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Carmel M. Hawley
- Department of NephrologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Australiasian Kidney Trials NetworkUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Peter G. Kerr
- Department of MedicineMonash UniversityClaytonVictoriaAustralia
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
| | - Patrick Toby Coates
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Centre Northern Adelaide Renal Transplantation ServiceRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Noa Amir
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Allison Tong
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
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Pivert KA, Boyle SM, Halbach SM, Chan L, Shah HH, Waitzman JS, Mehdi A, Norouzi S, Sozio SM. Impact of the COVID-19 Pandemic on Nephrology Fellow Training and Well-Being in the United States: A National Survey. J Am Soc Nephrol 2021; 32:1236-1248. [PMID: 33658283 PMCID: PMC8259681 DOI: 10.1681/asn.2020111636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic's effects on nephrology fellows' educational experiences, preparedness for practice, and emotional wellbeing are unknown. METHODS We recruited current adult and pediatric fellows and 2020 graduates of nephrology training programs in the United States to participate in a survey measuring COVID-19's effects on their training experiences and wellbeing. RESULTS Of 1005 nephrology fellows-in-training and recent graduates, 425 participated (response rate 42%). Telehealth was widely adopted (90% for some or all outpatient nephrology consults), as was remote learning (76% of conferences were exclusively online). Most respondents (64%) did not have in-person consults on COVID-19 inpatients; these patients were managed by telehealth visits (27%), by in-person visits with the attending faculty without fellows (29%), or by another approach (9%). A majority of fellows (84%) and graduates (82%) said their training programs successfully sustained their education during the pandemic, and most fellows (86%) and graduates (90%) perceived themselves as prepared for unsupervised practice. Although 42% indicated the pandemic had negatively affected their overall quality of life and 33% reported a poorer work-life balance, only 15% of 412 respondents who completed the Resident Well-Being Index met its distress threshold. Risk for distress was increased among respondents who perceived the pandemic had impaired their knowledge base (odds ratio [OR], 3.04; 95% confidence interval [CI], 2.00 to 4.77) or negatively affected their quality of life (OR, 3.47; 95% CI, 2.29 to 5.46) or work-life balance (OR, 3.16; 95% CI, 2.18 to 4.71). CONCLUSIONS Despite major shifts in education modalities and patient care protocols precipitated by the COVID-19 pandemic, participants perceived their education and preparation for practice to be minimally affected.
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Affiliation(s)
- Kurtis A. Pivert
- Data Science and Public Impact, American Society of Nephrology, Washington, DC
| | - Suzanne M. Boyle
- Section of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Susan M. Halbach
- Department of Pediatrics, Division of Nephrology, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - Lili Chan
- Charles Bronfman Institute of Personalized Medicine, Department of Genetics and Genomics; Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hitesh H. Shah
- Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Joshua S. Waitzman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ali Mehdi
- Department of Nephrology and Hypertension—Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sayna Norouzi
- Department of Nephrology, Loma Linda University Medical Center, Loma Linda, California
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine; and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Lambooy S, Krishnasamy R, Pollock A, Hilder G, Gray NA. Telemedicine for Outpatient Care of Kidney Transplant and CKD Patients. Kidney Int Rep 2021; 6:1265-1272. [PMID: 34013104 PMCID: PMC8116750 DOI: 10.1016/j.ekir.2021.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/17/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Telehealth videoconferencing (TVC) may improve access in rural areas, but reported uptake and outcomes among kidney transplant recipients (KTRs) and chronic kidney disease (CKD) patients are limited. This study aimed to assess the feasibility, sustainability, and clinical outcomes of TVC for this patient population. METHODS A total of 64 participants were recruited in this single-center, prospective, 2-year longitudinal, case-control study. Inclusion criteria for the telemedicine group included travel of ≥15 km to the hospital, and the control group was matched for transplant or CKD status, age, and sex. The primary outcome was feasibility (≥50% of consultations for each individual patient in the telemedicine group being conducted by TVC in year 1). Secondary outcomes were sustainability of telemedicine, change in blood pressure and creatinine, hospitalization, and travel distance. RESULTS There were 32 participants in both the telemedicine and control arms, with no baseline differences. The majority were male (65.6%) and the mean age was 63.9 years (SD = 12.3 years). TVC uptake in year 1 in the telemedicine arm was 71% (interquartile range [IQR] = 50.0-100.0) but reduced significantly in year 2 (50.0% [IQR = 33.3-71.4], P < 0.01). No significant differences in creatinine or blood pressure were observed between groups, including in the KTRs and CKD subgroup analysis. Patient satisfaction remained high for both groups. Compared with travel distance required if TVC was unavailable, travel distance in the TVC group decreased by 48% (16,644 km) in year 1 and by 37.0% (8177 km) in year 2. CONCLUSION TVC was feasible and sustainable, with outcomes comparable to those of standard care. Larger studies, especially among KTRs, are needed to confirm these findings.
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Affiliation(s)
- Sebastiaan Lambooy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- The University of Queensland, Herston, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Andrea Pollock
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Gerald Hilder
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Nicholas A. Gray
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- Sunshine Coast Health Institute, Birtinya, Queensland, Australia
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Cheung KL, Tamura MK, Stapleton RD, Rabinowitz T, LaMantia MA, Gramling R. Feasibility and Acceptability of Telemedicine-Facilitated Palliative Care Consultations in Rural Dialysis Units. J Palliat Med 2021; 24:1307-1313. [PMID: 33470899 DOI: 10.1089/jpm.2020.0647] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients receiving dialysis have unmet palliative care needs. Limited access to palliative care is a key barrier to its integration into routine dialysis care. Objective: To determine the feasibility and acceptability of telepalliative care in rural dialysis units. Methods: This was a single-arm pilot clinical trial. The target population was patients with kidney failure receiving outpatient dialysis in a rural U.S. state. Feasibility was measured by one-month completion rate. Acceptability was measured using an adapted telemedicine questionnaire. Results: We recruited 39 patients with mean age 71.2 years to undergo a telepalliative care consultation while receiving dialysis. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted the visits. The recruitment rate was 40% (39/96), scheduling rate was 100% (39/39), and one-month completion rate was 77% (30/39). Thirty-six patient participants (14 women and 22 men) completed the baseline survey. Audiovisual aspects of the visit were rated highly. More than 80% reported the visit being at least as good as an in-person visit and 41% felt the teleconsult was better. Eighty-one percent of patients felt the appointment was relevant to them, 58% felt they learned new things about their condition, and 27% reported the appointment changed the way they think about dialysis. Discussion: Telepalliative care is acceptable to patients receiving dialysis and is a feasible approach to integrating palliative care in rural dialysis units. The study was registered with Clinicaltrials.gov (NCT03744117).
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Affiliation(s)
- Katharine L Cheung
- Division of Nephrology, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
| | - Manjula Kurella Tamura
- Division of Nephrology, Geriatric Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Renee D Stapleton
- Division of Pulmonary and Critical Care, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
| | - Terry Rabinowitz
- Department of Psychiatry, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
| | - Michael A LaMantia
- Division of Geriatrics, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
| | - Robert Gramling
- Division of Palliative Medicine, Department of Family Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
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15
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Belcher JM. The Role of Telenephrology in the Management of CKD. KIDNEY360 2020; 1:1310-1315. [PMID: 35372872 PMCID: PMC8815503 DOI: 10.34067/kid.0000802019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 09/21/2020] [Indexed: 06/01/2023]
Affiliation(s)
- Justin M. Belcher
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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Teoh CW, Gaudreault-Tremblay MM, Blydt-Hansen TD, Goldberg A, Arora S, Feber J, Langlois V, Ruhl M, Phan V, Morgan C, Acott P, Hamiwka L. Management of Pediatric Kidney Transplant Patients During the COVID-19 Pandemic: Guidance From the Canadian Society of Transplantation Pediatric Group. Can J Kidney Health Dis 2020; 7:2054358120967845. [PMID: 33240516 PMCID: PMC7672730 DOI: 10.1177/2054358120967845] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE OF THE PROGRAM To provide guidance on the management of pediatric kidney transplant patients during the COVID-19 pandemic. SOURCES OF INFORMATION Program-specific documents, preexisting, and related to COVID-19; documents from provincial, national, and international kidney transplant societies/agencies and organ procurement agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature. METHODS Challenges in the care of pediatric kidney transplant patients during the COVID-19 pandemic were highlighted within the Canadian Society of Transplantation (CST) Pediatric Group. It identified pediatric kidney transplant nephrologists (including a pediatric nephrologist ethicist) across the country and formed a workgroup. The initial guidance document was drafted and members of the workgroup reviewed and discussed all suggestions in detail via e-mail and virtual meetings. Disagreements were resolved by consensus. The document was reviewed by the CST Kidney Transplant Working Group, by the Canadian Society of Nephrology (CSN) COVID-19 Rapid Response Team (RRT), and an infectious disease expert. The suggestions were presented at an interactive webinar sponsored by CSN in collaboration with the CST and Canadian Association of Pediatric Nephrologists (CAPN), and attended by pediatric kidney health care professionals for further peer input. Final revisions were made based on feedback received. CJKHD editors reviewed the parallel process peer review and edited the manuscript for clarity. KEY FINDINGS We identified 8 key areas of pediatric kidney transplant care that may be affected by the COVID-19 pandemic: (1) transplant activity, (2) outpatient clinic activity, (3) monitoring, (4) multidisciplinary care, (5) medications (immunosuppression and others), (6) patient/family education/support, (7) school and employment, and (8) management of pediatric kidney transplant patients who are COVID-19 positive. We make specific suggestions for each of these areas. LIMITATIONS A full systematic review of available literature was not undertaken for the sake of expediency in development of this guideline. There is a paucity of literature to support evidence-based recommendations at this time. Instead, these guidelines were formulated based on expert opinion derived from available knowledge/experience and are subject to the biases associated with this level of evidence. The parallel review process that was created to expedite the publication of this work may not be as robust as standard arms' length peer review processes. IMPLICATIONS These recommendations are meant to serve as a guide to pediatric kidney transplant directors, clinicians, and administrators for providing the best patient care in the context of limited resources while protecting patients and health care providers wherever possible by limiting exposure to COVID-19. We recognize that recommendations may not be applicable to all provincial/local health authority practices and that they may not be delivered to all patients given the time and resource constraints affecting the individual provincial/local health jurisdiction.
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Affiliation(s)
- Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | | | - Tom D. Blydt-Hansen
- Division of Nephrology, BC Children’s Hospital, Vancouver, Canada
- Department of Paediatrics, The University of British Columbia, Vancouver, Canada
| | - Aviva Goldberg
- Division of Nephrology, The Children’s Hospital of Winnipeg, MB, Canada
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Steven Arora
- Division of Nephrology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Janusz Feber
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
- Department of Paediatrics, University of Ottawa, ON, Canada
| | - Valerie Langlois
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, ON, Canada
| | - Michelle Ruhl
- Division of Nephrology, Jim Pattison Children’s Hospital, Saskatoon, SK, Canada
- Department of Paediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Veronique Phan
- Division of Nephrology, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Paediatrics, University de Montreal, QC, Canada
| | - Catherine Morgan
- Division of Nephrology, Stollery Children’s Hospital, Edmonton, AB, Canada
- Department of Paediatrics, University of Alberta, Edmonton, Canada
| | - Philip Acott
- Division of Nephrology, IWK Health Centre, Halifax, NS, Canada
- Department of Paediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lorraine Hamiwka
- Division of Nephrology, Alberta Children’s Hospital, Calgary, Canada
- Department of Paediatrics, University of Calgary, AB, Canada
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17
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Jain G, Ahmad M, Wallace EL. Technology, Telehealth, and Nephrology: The Time Is Now. KIDNEY360 2020; 1:834-836. [PMID: 35372956 PMCID: PMC8815747 DOI: 10.34067/kid.0002382020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Gaurav Jain
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Masood Ahmad
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric L. Wallace
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis — particularly haemodialysis and most notably in high-income countries (HICs) — the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization. Dialysis is a life-saving therapy; however, costs of dialysis are high, access is inequitable and outcomes are inadequate. This Review describes the current landscape of dialysis therapy from an epidemiological, economic, ethical and patient-centred framework, and describes initiatives that are aimed at stimulating innovations in the field to one that supports high-quality, high-value care. The global dialysis population is growing rapidly, especially in low-income and middle-income countries; however, worldwide, a substantial number of people lack access to kidney replacement therapy, and millions of people die of kidney failure each year, often without supportive care. The costs of dialysis care are high and will likely continue to rise as a result of increased life expectancy and improved therapies for causes of kidney failure such as diabetes mellitus and cardiovascular disease. Patients on dialysis continue to bear a high burden of disease, shortened life expectancy and report a high symptom burden and a low health-related quality of life. Patient-focused research has identified fatigue, insomnia, cramps, depression, anxiety and frustration as key symptoms contributing to unsatisfactory outcomes for patients on dialysis. Initiatives to transform dialysis outcomes for patients require both top-down efforts (that is, efforts that promote incentives based on systems level policy, regulations, macroeconomic and organizational changes) and bottom-up efforts (that is, patient-led and patient-centred advocacy efforts as well as efforts led by individual teams of innovators). Patients, payors, regulators and health-care systems increasingly demand improved value in dialysis care, which can only come about through true patient-centred innovation that supports high-quality, high-value care.
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Lameire N, Sever MS, Van Biesen W, Vanholder R. Role of the International and National Renal Organizations in Natural Disasters: Strategies for Renal Rescue. Semin Nephrol 2020; 40:393-407. [DOI: 10.1016/j.semnephrol.2020.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Lea JP, Tannenbaum J. The Role of Telemedicine in Providing Nephrology Care in Rural Hospitals. KIDNEY360 2020; 1:553-556. [PMID: 35368600 DOI: 10.34067/kid.0001122019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Janice P Lea
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia
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21
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Zuniga C, Riquelme C, Muller H, Vergara G, Astorga C, Espinoza M. Using Telenephrology to Improve Access to Nephrologist and Global Kidney Management of CKD Primary Care Patients. Kidney Int Rep 2020; 5:920-923. [PMID: 32518875 PMCID: PMC7270717 DOI: 10.1016/j.ekir.2020.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Carlos Zuniga
- School of Medicine, Universidad Catolica de la Santisima Concepcion, Bío Bío, Chile.,Service of Nephrology, Hospital Las Higueras, Talcahuano, Chile.,School of Medicine, Universidad de Concepcion, Bío Bío, Chile
| | - Cecilia Riquelme
- Servicio Salud Concepcion, Hospital Regional of Concepcion, Bío Bío, Chile
| | - Hans Muller
- Service of Nephrology, Hospital Las Higueras, Talcahuano, Chile.,School of Medicine, Universidad de Concepcion, Bío Bío, Chile
| | | | - Camila Astorga
- Servicio Salud Concepcion, Hospital Regional of Concepcion, Bío Bío, Chile
| | - Manuel Espinoza
- Faculty of Medicine, Pontificia Universidad Catolica, Santiago, Chile
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22
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Michel LM, Baroux N, Frimat L, Quirin N. Telenephrology and on-site nephrology: Comparable adequate dialysis care to patients living in remote Pacific Islands. J Telemed Telecare 2020; 27:562-571. [DOI: 10.1177/1357633x19896680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction End-stage renal disease is a major public health concern in New Caledonia and in Wallis and Futuna (prevalence value: 2542 per million population in 2017). Spread over the territory, 594 dialysis patients are followed up by nephrologists and partially by telemedicine due to the distance. The aim of our this study was to evaluate the quality of care provided by telemedicine for chronic dialysis patients on Wallis Island, a dialysis unit remote from Noumea (2100 km). Methods We compared two populations of haemodialysis patients, one based in Poindimie in New Caledonia and followed by monthly physical consultation, the other based on Wallis Island and followed by monthly teleconsultation and quarterly on-site consultation. Results From January 2012–December 2017, dialysis adequacy and survival data were recorded for 84 patients: 44 in Poindimie, 40 on Wallis Island. Dialysis adequacy (i.e. clinical, biological parameters) as well as occurrence of vascular access complications were no different regardless of the means of follow-up. During the study, 23 deaths occurred (11 in Poindimie, 12 on Wallis Island; p = 0.464). We did not find any difference in survival at one and six years ( p = 0.46) between the two dialysis units. Evaluation for transplantation was lower for Wallisian patients ( p = 0.042), without impact on the number of patients being transplanted ( p = 0.678). Conclusion Telemedicine is a valuable opportunity for the follow-up of remote chronic haemodialysis patients, allowing them to be treated close to home while ensuring optimal quality of care
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Affiliation(s)
- Laurie-Mathilde Michel
- Service de Néphrologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre Cedex, New Caledonia
| | - Noémie Baroux
- Reseau de l’Insuffisance Renale en Nouvelle-Caledonie, Noumea Cedex, New Caledonia
| | - Luc Frimat
- Service de Néphrologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre Cedex, New Caledonia
| | - Nicolas Quirin
- Nephrology Department, Centre Hospitalier Territorial Gaston Bourret, Noumea Cedex, New Caledonia
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23
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Pape L, Schneider N, Schleef T, Junius-Walker U, Haller H, Brunkhorst R, Hellrung N, Prokosch HU, Haarbrandt B, Marschollek M, Schiffer M. The nephrology eHealth-system of the metropolitan region of Hannover for digitalization of care, establishment of decision support systems and analysis of health care quality. BMC Med Inform Decis Mak 2019; 19:176. [PMID: 31477119 PMCID: PMC6720092 DOI: 10.1186/s12911-019-0902-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background Even though a high demand for sector spanning communication exists, so far no eHealth platform for nephrology is established within Germany. This leads to insufficient communication between medical providers and therefore suboptimal nephrologic care. In addition, Clinical Decision Support Systems have not been used in Nephrology until now. Methods The aim of NEPHRO-DIGITAL is to create a eHealth platform in the Hannover region that facilitates integrated, cross-sectoral data exchange and includes teleconsultation between outpatient nephrology, primary care, pediatricians and nephrology clinics to reduce communication deficits and prevent data loss, and to enable the creation and implementation of an interoperable clinical decision support system. This system will be based on input data from multiple sources for early identification of patients with cardiovascular comorbidity and progression of renal insufficiency. Especially patients will be able to enter and access their own data. A transfer to a second nephrology center (metropolitan region of Erlangen-Nuremburg) is included in the study to prove feasibility and scalability of the approach. Discussion A decision support system should lead to earlier therapeutic interventions and thereby improve the prognosis of patients as well as their treatment satisfaction and quality of life. The system will be integrated in the data integration centres of two large German university medicine consortia (HiGHmed (highmed.org) and MIRACUM (miracum.org)). Trial registration ISRCTN16755335 (09.07.2019).
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Affiliation(s)
- L Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
| | - N Schneider
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - T Schleef
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - U Junius-Walker
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - H Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - R Brunkhorst
- Department of Nephrology, Angiology and Rheumatology, KRH Regional Hospital Hannover Siloah, Hannover, Germany
| | | | - H U Prokosch
- Department of Medical Informatics, Biometrics and Epidemiology, Chair for Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - B Haarbrandt
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany
| | - M Marschollek
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany
| | - M Schiffer
- Department of Nephrology, University Hospital Erlangen, Erlangen, Germany
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25
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Simon P. Télésurveillance des traitements de suppléance rénale. Nephrol Ther 2019; 15 Suppl 1:S65-S78. [DOI: 10.1016/j.nephro.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Lunyera J, Diamantidis CJ. Novel Models for Health Care Delivery for CKD for Disadvantaged Populations. Clin J Am Soc Nephrol 2018; 13:1779-1780. [PMID: 30442865 PMCID: PMC6302321 DOI: 10.2215/cjn.12591018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Affiliation(s)
- Joseph Lunyera
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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27
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Venuthurupalli SK, Rolfe A, Fanning J, Cameron A, Hoy WE. Chronic Kidney Disease, Queensland (CKD.QLD) Registry: Management of CKD With Telenephrology. Kidney Int Rep 2018; 3:1336-1343. [PMID: 30450460 PMCID: PMC6224628 DOI: 10.1016/j.ekir.2018.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Enabled by the Chronic Kidney Disease, Queensland (CKD.QLD) Registry, we aim to outline the structure, implementation, and outcomes of telenephrology clinics for the management of patients with chronic kidney disease (CKD) in rural, regional, and remote areas of the Darling Downs region in Queensland, Australia. METHODS This is an observational registry-based study involving adult patients with CKD, attending specialist clinics, and residing ≥50 km away from Toowoomba Hospital. The telenephrology cohort (TC) included those who had their follow-up appointments via videoconference at local Queensland Health facilities, and the standard care cohort (SCC) included those who continue to have their follow-up in Toowoomba Hospital. RESULTS A total of 234 patients with CKD were seen via videoconference clinics between September 1, 2011 and December 31, 2016, representing 22.2% of the CKD registry cohort from Toowoomba Hospital. The baseline characteristics and comorbid profiles of both groups were similar. The Aboriginal population was overrepresented in the TC (22.2% vs. 5.9%). As a group for each visit, the TC traveled 100,000 km less (both ways) to see a specialist physically. During follow-up, 5.1% of patients in the TC were initiated on dialysis whereas 9.9% were initiated on dialysis in the SCC (P = 0.02). There was lower mortality in the TC (11.1% vs. 18.2%; P = 0.02). CONCLUSION Telenephrology clinics were safe, economical, and efficient for the delivery of specialist care for patients with CKD living at a distance from the main referral hospital. Such care was comparable to standard care delivered at the main hospital but with clear benefits to the patients in terms of reduced travel distance, more independence, and similar outcomes.
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Affiliation(s)
- Sree K Venuthurupalli
- Renal Services, Toowoomba Hospital, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
- Centre for Chronic Disease, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Rolfe
- Renal Unit, Kingaroy Hospital, Kingaroy, Queensland, Australia
| | - John Fanning
- Renal Services, Toowoomba Hospital, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
| | - Anne Cameron
- Centre for Chronic Disease, The University of Queensland, Brisbane, Queensland, Australia
| | - Wendy E Hoy
- Centre for Chronic Disease, The University of Queensland, Brisbane, Queensland, Australia
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Bieber SD, Weiner DE. Telehealth and Home Dialysis: A New Option for Patients in the United States. Clin J Am Soc Nephrol 2018; 13:1288-1290. [PMID: 30042227 PMCID: PMC6086722 DOI: 10.2215/cjn.03010318] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Scott D. Bieber
- Division of Nephrology, University of Washington Medicine, Harborview Medical Center, Seattle, Washington; and
| | - Daniel E. Weiner
- William B. Schwartz Division of Nephrology. Tufts Medical Center, Boston, Massachusetts
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Crowley ST, Murphy K. Delivering a "New Deal" of Kidney Health Opportunities to Improve Outcomes Within the Veterans Health Administration. Am J Kidney Dis 2018; 72:444-450. [PMID: 29627134 DOI: 10.1053/j.ajkd.2018.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/22/2018] [Indexed: 11/11/2022]
Abstract
Just as the "New Deal" aimed to elevate the "forgotten man" of the Great Depression through governmental relief and reform, so does the Department of Veterans Affairs (VA) health care system aim to improve the health of veterans with the invisible illness of chronic kidney disease through a concerted series of health care delivery reforms. Augmenting its primary care platform with advances in informatics and health service delivery initiatives targeting kidney disease, the VA is changing how nephrology care is provided to veterans with the goal of optimized population kidney health. As the largest provider of kidney health services in the country, the VA offers an instructive case study of the value of comprehensive health care coverage for people with chronic kidney disease. Recent reports of kidney health outcomes among veterans support the benefit of the VA's integrated health care delivery system. Suggestions to optimize veterans' kidney health further may be equally applicable to other health systems caring for people afflicted with kidney disease.
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Affiliation(s)
- Susan T Crowley
- Veterans Health Administration, Specialty Care Services/Office of Policy and Services, West Haven, CT; Section of Nephrology, Department of Medicine, Yale University School of Medicine, West Haven, CT.
| | - Katherine Murphy
- Veterans Health Administration, Specialty Care Services/Office of Policy and Services, West Haven, CT
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