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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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Sansuk J, Sornlorm K. Spatial associations between chronic kidney disease and socio-economic factors in Thailand. GEOSPATIAL HEALTH 2024; 19. [PMID: 38288788 DOI: 10.4081/gh.2024.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
Chronic kidney disease (CKD) is a persistent, progressive condition characterized by gradual decline of kidney functions leading to a range of health issues. This research used recent data from the Ministry of Public Health in Thailand and applied spatial regression and local indicators of spatial association (LISA) to examine the spatial associations with night-time light, Internet access and the local number of health personnel per population. Univariate Moran's I scatter plot for CKD in Thailand's provinces revealed a significant positive spatial autocorrelation with a value of 0.393. High-High (HH) CKD clusters were found to be predominantly located in the North, with Low-Low (LL) ones in the South. The LISA analysis identified one HH and one LL with regard to Internet access, 15 HH and five LL clusters related to night-time light and eight HH and five LL clusters associated with the number of health personnel in the area. Spatial regression unveiled significant and meaningful connections between various factors and CKD in Thailand. Night-time light displayed a positive association with CKD in both the spatial error model (SEM) and the spatial lag model (SLM), with coefficients of 3.356 and 2.999, respectively. Conversely, Internet access exhibited corresponding negative CKD associations with a SEM coefficient of - 0.035 and a SLM one of -0.039. Similarly, the health staff/population ratio also demonstrated negative associations with SEM and SLM, with coefficients of -0.033 and -0.068, respectively. SEM emerged as the most suitable spatial regression model with 54.8% according to R2. Also, the Akaike information criterion (AIC) test indicated a better performance for this model, resulting in 697.148 and 698.198 for SEM and SLM, respectively. These findings emphasize the complex interconnection between factors contributing to the prevalence of CKD in Thailand and suggest that socioeconomic and health service factors are significant contributing factors. Addressing this issue will necessitate concentrated efforts to enhance access to health services, especially in urban areas experiencing rapid economic growth.
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Affiliation(s)
- Juree Sansuk
- Faculty of Nursing, Boromarajonani College of Nursing, Khon Kaen.
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Catapan SDC, Haydon HM, Hickman IJ, Webb L, Isbel N, Johnson D, Campbell KL, Mayr HL, Canfell O, Scuffham P, Burton N, Caffery LJ, Smith AC, Kelly JT. Trust and confidence in using telehealth in people with chronic kidney disease: A cross-sectional study. J Telemed Telecare 2023; 29:16S-23S. [PMID: 38007696 DOI: 10.1177/1357633x231202275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Consumer trust and confidence in telehealth is pivotal to successful service implementation and effective consultations. This cross-sectional study measured trust and confidence in telephone and video consultations and associated with experience in telehealth modalities among people with chronic kidney disease at a metropolitan hospital in Australia. Self-report data were collected using validated trust and confidence in telehealth scales and 5-point Likert responses. Non-parametric tests were used to compare trust and confidence in telephone and video consultations (Wilcoxon Matched Pairs) and associations with telehealth experience (Mann-Whitney). Of the 156 survey participants, 96.2% had used telephone consultations and 28.9% had used video. Overall trust and confidence in using telehealth were high. Confidence (range 1-5) in using telephone consultations (mean 3.75 ± 0.71) was significantly higher than video consultation (mean 3.64 ± 0.74), p = 0.039. Trust in telephone consultations (mean 3.93 ± 0.64) was significantly higher than in video consultations (mean 3.67 ± 0.66), p < 0.001. There was a significant association between experience with telephone consultations and reported levels of trust and confidence in telephone consultations. Experience with video was significantly related to trust in video consultations, but not confidence. Given the substantial difference in experience between telehealth modalities, trust and confidence may change as further exposure occurs.
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Affiliation(s)
- Soraia de Camargo Catapan
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole Isbel
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David Johnson
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Katrina L Campbell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Hannah L Mayr
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Oliver Canfell
- Queensland Digital Health Centre, Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicola Burton
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
- Centre for Mental Health, Griffith University, Mount Gravatt, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Kelly JT, Jegatheesan DK, Dawson J, Barnett A, Khor BH, Chang AR, Carrero JJ, Campbell KL. Are Digital Health Technologies and Models of Nutrition Care the Future of Chronic Kidney Disease Management? J Ren Nutr 2023; 33:S80-S87. [PMID: 36965753 DOI: 10.1053/j.jrn.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/11/2022] [Accepted: 02/27/2023] [Indexed: 03/27/2023] Open
Abstract
People living with chronic kidney disease (CKD) require long-term support at varying levels of individualization, intensity, and frequency. Mobile and digital models of nutrition care can facilitate long-term behavior change, address nutrition issues proactively, reduce travel burden, and reach people without access to health care more easily. However, while traditional health delivery continues to be digitally disrupted, there are many barriers to address before mobile and digitally supported models of nutrition care can become business as usual in nephrology and nutrition care practice. This paper overviews the current evidence base concerning the past and present mobile and digital health programs to improve nutrition in CKD and highlights the novel future trends in this field. The way nutrition and dietetic care can be feasible, safe, and potentially effective when delivered using various digital and virtual technologies, including consultations, assessments, establishment of diagnoses, formulation of plans, and monitoring/reviewing clinical progress is discussed. Of the available evidence to date, these modalities appear to improve dietary sodium intake and diet quality, self-efficacy, interdialytic weight gain, and body weight. Many barriers exist to sustaining the continued and widespread adoption of digital and mobile health-supported nutrition care in CKD. These include patient-, clinician-, and health system-specific and are discussed in detail. Mobile and digital-supported models of nutrition care present an exciting opportunity to assist kidney dietitians deliver patient-centred nutrition care in CKD.
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Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Dev K Jegatheesan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Jessica Dawson
- Nutrition and Dietetics Department, St George Hospital, Sydney, New South Wales, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Amandine Barnett
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Alex R Chang
- Center for Kidney Health Research, Geisinger Health, Danville, PA
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Katrina L Campbell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Australia
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5
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Hosseini A, Jackson AC, Chegini N, Dehghan MF, Mazloum D, Haghani S, Bahramnezhad F. The effect of an educational app on hemodialysis patients' self-efficacy and self-care: A quasi-experimental longitudinal study. Chronic Illn 2023; 19:383-394. [PMID: 35179394 DOI: 10.1177/17423953211073365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Adequate self-care and exploring ways to improve it is imperative for patients with hemodialysis in order to meet the challenges arising from hemodialysis. This study aimed to determine the effect of an educational app on patients with hemodialysis' self-efficacy and self-care. METHODS The present study is a quasi-experimental longitudinal single-group study, carried out from October 2020 to March 2021 with the participation of 60 Patients with hemodialysis. Simple random sampling was used to sample patients. The intervention included an educational application, and participants completed questionnaires on self-efficacy and self-care performance at four points including baseline and at one, three, and six-month intervals post- intervention. Two-way ANOVA with repeated measures was used to examine the impact of the intervention. Bonferroni's posthoc test was also used for in-class calculation and comparison of changes over various periods. RESULTS The results of this study showed that the self-care performance of patients at different times was statistically significant (P <0.001). Also, the results showed that the mean total score of self-efficacy in the second period compared to the first was significantly improved (P <0.001). But the trend of changes in the third period compared to the second and the fourth to the third was not significant (p = 0.1 and p = .82). Also, a significant change was observed in the fourth period compared to the first (p = .029). CONCLUSIONS The study showed that education through a mobile app can result in significant improvements in these patients' self-care behaviors and self-efficacy over time. The educational intervention should be provided to patients with hemodialysis over a several-month period to allow for proper integration of the learning.
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Affiliation(s)
- Amin Hosseini
- School of Nursing and Midwifery, Department of Medical Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, School of Nursing and Midwifery, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Alun C Jackson
- Australian Centre for Heart Health, Melbourne, Australia.,Faculty of Health, 95522Deakin University, Geelong, Australia.,Centre on Behavioural Health, Hong Kong University, Hong Kong, PRC
| | - Najmeh Chegini
- Students' Scientific Research Center, School of Nursing and Midwifery, 48439Tehran University of Medical Sciences, Tehran, Iran
| | | | - Danyal Mazloum
- Students' Scientific Research Center, School of Nursing and Midwifery, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- School of Nursing and Midwifery, Department of Medical Surgical Nursing, 440827Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bahramnezhad
- Department of ICU and Nursing Management, School of Nursing & Midwifery, Nursing and Midwifery Care Research Center, 48439Tehran University of Medical Sciences, Tehran, Iran.,Spiritual Health Group, Research Center of Quran, Hadith and Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran
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6
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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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Brown RCC, Jegatheesan DK, Conley MM, Mayr HL, Kelly JT, Webb L, Barnett A, Staudacher HM, Burton NW, Isbel NM, Macdonald GA, Campbell KL, Coombes JS, Keating SE, Hickman IJ. U-DECIDE: Utilising technology for Diet & Exercise Change In complex chronic conditions across Diverse Environments: Protocol for a Randomised Controlled Trial (Preprint). JMIR Res Protoc 2022; 11:e37556. [PMID: 35900834 PMCID: PMC9377441 DOI: 10.2196/37556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background The metabolic syndrome is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. Objective The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. Methods The study is a single-center, 26-week, randomized controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the metabolic syndrome. All participants will receive an individualized assessment and advice on diet quality from a dietitian, a wearable activity monitor, and standard care. Participants randomized to the intervention group will receive access to a suite of health technologies from which to choose, including common base components (text messages) and optional components (online and mobile app–based nutrition information, an online home exercise program, and group-based videoconferencing). Exposure to the optional aspects of the intervention will be patient-led, with participants choosing their preferred level of engagement. The primary outcome will be the feasibility of delivering the program, determined by safety, recruitment rate, retention, exposure uptake, and telehealth adherence. Secondary outcomes will be clinical effectiveness, patient-led goal attainment, treatment fidelity, exposure demand, and participant perceptions. Primary outcome data will be assessed descriptively and secondary outcomes will be assessed using an analysis of covariance. This study will provide evidence on the feasibility of the intervention in a tertiary setting for patients with complex chronic disease exhibiting features of the metabolic syndrome. Results The study was funded in 2019. Enrollment has commenced and is expected to be completed by June 2022. Data collection and follow up are expected to be completed by December 2022. Results from the analyses based on primary outcomes are expected to be submitted for publication by June 2023. Conclusions The study will test the implementation of a health technology–assisted lifestyle intervention in a tertiary outpatient setting for a diverse group of patients with complex chronic conditions. It is novel in that it embeds patient choice into intervention exposure and will inform health service decision-makers in regards to the feasibility of scale and spread of technology-assisted access to care for a broader reach of specialist services. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12620001282976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378337 International Registered Report Identifier (IRRID) DERR1-10.2196/37556
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Affiliation(s)
- Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Dev K Jegatheesan
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Nutrition and Dietetics Research Group, Bond University, Robina, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Heidi M Staudacher
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Melbourne, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Health, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
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Yu X, Nakayama M, Wu MS, Kim YL, Mushahar L, Szeto CC, Schatell D, Finkelstein FO, Quinn RR, Duddington M. Shared Decision-Making for a Dialysis Modality. Kidney Int Rep 2022; 7:15-27. [PMID: 35005310 PMCID: PMC8720663 DOI: 10.1016/j.ekir.2021.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of kidney failure continues to rise globally. Dialysis is a treatment option for individuals with kidney failure; after the decision to initiate dialysis has been made, it is critical to involve individuals in the decision on which dialysis modality to choose. This review, based on evidence arising from the literature, examines the role of shared decision-making (SDM) in helping those with kidney failure to select a dialysis modality. SDM was found to lead to more people with kidney failure feeling satisfied with their choice of dialysis modality. Individuals with kidney failure must be cognizant that SDM is an active and iterative process, and their participation is essential for success in empowering them to make decisions on dialysis modality. The educational components of SDM must be easy to understand, high quality, unbiased, up to date, and targeted to the linguistic, educational, and cultural needs of the individual. All individuals with kidney failure should be encouraged to participate in SDM and should be involved in the design and implementation of SDM approaches.
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Affiliation(s)
- Xueqing Yu
- Division of Nephrology, Guangdong Provincial People’s Hospital, Guangzhou, People’s Republic of China
- Correspondence: Xueqing Yu, Division of Nephrology, Guangdong Provincial People’s Hospital, 106th, Zhongshan Road II, Guangzhou 510080, People’s Republic of China.
| | | | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Lily Mushahar
- Department of Nephrology, Hospital Tuanku Ja'afar, Seremban, Malaysia
| | - Cheuk Chun Szeto
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Dori Schatell
- Medical Education Institute, Inc., Madison, Wisconsin, USA
| | | | - Robert R. Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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9
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Kaboutari-Zadeh L, Azizi A, Ghorbani A, Azizi A. Designing and evaluating a mobile personal health record application for kidney transplant patients. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Marinho CLA, Gomes OV, da Silva GB, Schwingel PA. Smartphone and application use in self-management of chronic kidney disease: a cross-sectional feasibility study. SAO PAULO MED J 2022; 141:e202278. [PMID: 36197350 PMCID: PMC10065095 DOI: 10.1590/1516-3180.2022.0078.r2.09082022] [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: 01/30/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Smartphone and application use can improve communication and monitoring of chronic diseases, including chronic kidney disease, through self-management and increased adherence to treatment. OBJECTIVE To assess smartphone use in patients with chronic kidney disease on dialysis and their willingness to use mobile applications as a disease self-management strategy. DESIGN AND SETTING This was a cross-sectional study of chronic kidney disease patients on hemodialysis in the São Francisco Valley in the Northeast Region, Brazil. METHODS The questionnaire developed by the authors was administered between April and June 2021. Cronbach's alpha coefficient for the construct was 0.69. Associations between the dependent and independent variables were determined using univariate analysis. Multivariate analysis with logistic regression analysis was also performed. RESULTS A total of 381 patients were included, of whom 64% had a smartphone, although only 3.1% knew of a kidney disease-related application. However, 59.3% believed that using an application could help them manage their disease. Having a smartphone was associated with treatment adherence, higher educational attainment, and higher per capita income. Educational attainment remained an independent factor in multivariate analysis. CONCLUSION More than 64% of patients had a smartphone, although few knew of applications developed for kidney disease. More than half of the population believed that technology use could benefit chronic kidney disease treatment. Smartphone ownership was more common among the younger population, with higher educational attainment and income, and was associated with greater adherence to hemodialysis sessions.
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Affiliation(s)
| | - Orlando Vieira Gomes
- MD, MSc. Nephrologist and Assistant Professor, School of
Medicine, Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina
(PE), Brazil
| | - Geraldo Bezerra da Silva
- MD, PhD. Physician and Professor, Department of Internal
Medicine, School of Medicine, Universidade Federal do Ceará (UFC), and School of
Medicine, Public Health and Medical Sciences Graduate Programs, Universidade de
Fortaleza (UNIFOR), Fortaleza (CE), Brazil
| | - Paulo Adriano Schwingel
- PhD. Sports Physiologist and Associate Professor, Human
Performance Research Laboratory, Universidade de Pernambuco (UPE), Petrolina
(PE), Brazil
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11
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Donald M, Beanlands H, Straus S, Harwood L, Herrington G, Waldvogel B, Delgado M, Sparkes D, Watson P, Elliott M, McBrien K, Bello A, Hemmelgarn B. A Research Protocol for Implementation and Evaluation of a Patient-Focused eHealth Intervention for Chronic Kidney Disease. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:85-94. [PMID: 35402999 PMCID: PMC8938369 DOI: 10.1007/s43477-022-00038-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/13/2022] [Indexed: 02/02/2023]
Abstract
Self-management in chronic kidney disease (CKD) can slow disease progression; however, there are few tools available to support patients with early CKD. My Kidneys My Health is a patient-focused electronic health (eHealth) self-management tool developed by patients and caregivers. This study will investigate the implementation of My Kidneys My Health across primary care and general nephrology clinics. The study aims to: (1) identify and address barriers and facilitators that may impact implementation and sustainability of the website into routine clinical care; (2) evaluate implementation quality to inform spread and scale-up. We will conduct a multi-stage approach using qualitative methods, guided by the Quality Implementation Framework and using a qualitative content analysis approach. First, we will identify perceived barriers and facilitators to implementation and considerations for sustainability through interviews with clinicians, based on the Readiness Thinking Tool and the Long Term Success Tool. Analysis will be guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Appropriate implementation strategies will be identified using the Expert Recommendations for Implementing Change compilation, and implementation plans will be developed based on Proctor's recommendations and the Action, Actor, Context, Target, Time framework. Finally, we will explore implementation quality guided by the RE-AIM framework. There is limited literature describing systematic approaches to implementing and sustaining patient-focused self-management tools into clinical care, in addition to employing tailored implementation strategies to promote adoption and sustainability. We aim to generate insights on how My Kidneys My Health can be integrated into clinical care and how to sustain use of patient-centric eHealth tools in clinical settings on a larger scale. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00038-3.
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Affiliation(s)
- Maoliosa Donald
- Department of Medicine, University of Calgary, HSC G239, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Lori Harwood
- London Health Sciences Centre, London, ON Canada
| | | | | | | | | | - Paul Watson
- Can-SOLVE CKD Patient Partner, Vancouver, BC Canada
| | - Meghan Elliott
- Department of Medicine, University of Calgary, HSC G239, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Kerry McBrien
- Department of Family Medicine, University of Calgary, Calgary, AB Canada
| | - Aminu Bello
- Department of Medicine, University of Alberta, Edmonton, AB Canada
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12
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Tummalapalli SL, Cukor D, Bohmart A, Levine DM, Parker TS, Liu F, Perlman A, Srivatana V, Turchioe MR, Ibrahim SA, Silberzweig J. A Mobile Health-based Survey to Assess COVID-19 Vaccine Intent and Uptake Among Patients on Dialysis. Kidney Int Rep 2021; 7:633-637. [PMID: 34926872 PMCID: PMC8667463 DOI: 10.1016/j.ekir.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.,The Rogosin Institute, New York, NY.,Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Andrew Bohmart
- The Rogosin Institute, New York, NY.,Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Daniel M Levine
- The Rogosin Institute, New York, NY.,Department of Biochemistry, Weill Cornell Medicine, New York, NY
| | - Thomas S Parker
- The Rogosin Institute, New York, NY.,Department of Biochemistry, Weill Cornell Medicine, New York, NY
| | - Frank Liu
- The Rogosin Institute, New York, NY.,Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Alan Perlman
- The Rogosin Institute, New York, NY.,Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Vesh Srivatana
- The Rogosin Institute, New York, NY.,Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Meghan Reading Turchioe
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Said A Ibrahim
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jeffrey Silberzweig
- The Rogosin Institute, New York, NY.,Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY
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13
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Oshni Alvandi A, Bain C, Burstein F. Understanding digital health ecosystem from Australian citizens' perspective: A scoping review. PLoS One 2021; 16:e0260058. [PMID: 34780547 PMCID: PMC8592460 DOI: 10.1371/journal.pone.0260058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/30/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Digital health (DH) and the benefits of related services are fairly well understood. However, it still is critical to map the digital health care landscape including the key elements that define it as an ecosystem. Particularly, knowing the perspectives of citizens on this digital transformation is an important angle to capture. In this review we aim to analyze the relevant studies to identify how DH is understood and experienced by Australian citizens and what they may require from DH platforms. MATERIALS AND METHODS A scoping literature review was conducted across several electronic databases (ACM Digital Library, OVID, PubMed, Scopus, IEEE, Science Direct, SAGE), as well as grey literature. Additionally, citation mining was conducted to identify further relevant studies. Identified studies were subjected to eligibility criteria and the final set of articles was independently reviewed, analyzed, discussed and interpreted by three reviewers. RESULTS Of 3811 articles, 98 articles met the inclusion criteria with research-based articles-as opposed to review articles or white papers- comprising the largest proportion (72%) of the selected literature. The qualitative analysis of the literature revealed five key elements that capture the essence of the digital health ecosystem interventions from the viewpoint of the Australian citizens. The identified elements were "consumer/user", "health care", "technology", "use and usability", "data and information". These elements were further found to be associated with 127 subcategories. CONCLUSIONS This study is the first of its kind to analyze and synthesize the relevant literature on DH ecosystems from the citizens' perspective. Through the lens of two research questions, this study defines the key components that were found crucial to understanding citizens' experiences with DH. This understanding lays a strong foundation for designing and fostering DH ecosystem. The results provide a solid ground for empirical testing.
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Affiliation(s)
| | - Chris Bain
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Frada Burstein
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
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14
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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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15
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Ma T, Lambert K. What are the information needs and concerns of individuals with Polycystic Kidney Disease? Results of an online survey using Facebook and social listening analysis. BMC Nephrol 2021; 22:263. [PMID: 34261447 PMCID: PMC8281574 DOI: 10.1186/s12882-021-02472-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polycystic Kidney Disease (PKD) is a hereditary disorder that has no cure and can result in end stage kidney failure. Searching for health information online and via social media is a common phenomenon in many medical conditions. However, no recent studies have documented the information needs, online behaviours, and concerns of people with PKD. The aim of this study was to explore the information needs of individuals with PKD and their carers by documenting (i) the information needs (ii) online information health seeking behaviours (iii) the perceived challenges of living with PKD and (iv) dietary concerns. METHODS A 17-item survey was constructed by undertaking a social listening analysis. This survey was then distributed via PKD related social media groups on Facebook. Seven groups distributed the survey with permission from the group owners. Open free text survey questions were analysed thematically using content analysis. RESULTS A total of 536 respondents completed the online survey (70.9 % female, 77 % aged 35-70, 70.2 % diagnosed more than 10 years ago). The major information need expressed by participants with PKD was for dietary information. Information regarding medications, medical management and symptom control were also desired. The overarching themes arising from the free text responses to the major challenge of living with PKD included 'learning to navigate dietary ambiguities'; 'managing social, psychological and emotional needs'; and 'accepting an uncertain future'. In addition to a strong desire for practical and specific dietary information, participants expressed a need for more online information pertaining to management of fatigue, pain, complications and how to manage mental health. Online peer support was also highly regarded and desired. CONCLUSIONS This study provides contemporary insights into the type of information desired by people with PKD. The results indicated that there was a strong desire for unambiguous information and guidance from health professionals to facilitate self-management, alleviate concerns, and address the complexities of living with Polycystic Kidney Disease. While diet is an important and frequently expressed need, there also remains a large demand for information on how to support psychological needs, and on medical management in order to support treatment decision making. Future work is required to develop specific, actionable and evidence-based resources for patients that are available online and through health professionals. Increased access to renal dietitians, peer support and additional training for health professionals could also improve patient-centered care and support self-management.
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Affiliation(s)
- Tiffany Ma
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, 2522, Wollongong, NSW, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, 2522, Wollongong, NSW, Australia.
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16
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Dawson J, Lambert K, Campbell KL, Kelly JT. Incorporating digital platforms into nutritional care in chronic kidney disease. Semin Dial 2021. [PMID: 34235785 DOI: 10.1111/sdi.12998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Digital health is increasingly recognized for its value to enhance patient care and clinical care processes. People with chronic kidney disease often find dietary self-management challenging. There is promising evidence that digital health interventions can support people with chronic kidney disease to self-manage their diet, by providing more frequent access to nutritional information and dietitians and by facilitating regular monitoring and feedback. There is some emerging evidence of the impact of digital interventions in chronic kidney disease; however, more research is needed to provide meaningful interpretation of how digital interventions can enhance current practice. Importantly, a number of factors need to be considered when designing, developing, implementing, and evaluating the impact of digital interventions. Consideration of the nutrition service and patients' needs, motivation and digital literacy, type of digital intervention, and the ability to embed the digital intervention into current care processes are critical. This paper overviews the current literature on digital health and self-management, factors to consider when embedding digital interventions and platforms into nutrition care and practical considerations for designing and implementing digital health interventions to enhance the nutritional care of people with chronic kidney disease.
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Affiliation(s)
- Jessica Dawson
- Nutrition and Dietetics Department, St George Hospital, Sydney, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Centre of Applied Health Economics, School of Medicine, Griffith University, Nathan Campus, Nathan, Queensland, Australia
| | - Jaimon T Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
- Centre of Applied Health Economics, School of Medicine, Griffith University, Nathan Campus, Nathan, Queensland, Australia
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17
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Schrauben SJ, Appel L, Rivera E, Lora CM, Lash JP, Chen J, Hamm LL, Fink JC, Go AS, Townsend RR, Deo R, Dember LM, Feldman HI, Diamantidis CJ. Mobile Health (mHealth) Technology: Assessment of Availability, Acceptability, and Use in CKD. Am J Kidney Dis 2021; 77:941-950.e1. [PMID: 33309860 PMCID: PMC8154635 DOI: 10.1053/j.ajkd.2020.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/08/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Digital and mobile health (mHealth) technologies improve patient-provider communication and increase information accessibility. We assessed the use of technology, attitudes toward using mHealth technologies, and proficiency in using mHealth technologies among individuals with chronic kidney disease (CKD). STUDY DESIGN Cross-sectional survey with open text responses. SETTING & PARTICIPANTS Chronic Renal Insufficiency Cohort (CRIC) Study participants who completed current use and interest in using mHealth technologies questionnaires and the eHealth literacy Survey (eHEALS). EXPOSURE Participant characteristics. OUTCOMES Use of technology (ie, internet, email, smartphone, and mHealth applications [apps]), interest in future mHealth use, and proficiency in using digital and mHealth technologies, or eHealth literacy, determined by eHEALS score. ANALYTICAL APPROACH Poisson regression and a qualitative content analysis of open-ended responses. RESULTS Study participants (n = 932) had a mean age of 68 years old and an estimated glomerular filtration rate (eGFR) of 54 mL/min/1.73 m2, and 59% were male. Approximately 70% reported current use of internet, email, and smartphones, and 35% used mHealth apps; only 27% had adequate eHealth literacy (eHEALS score ≥ 32). Participants <65 years of age (vs. ≥65), with more education, higher income, better cognition, and adequate health literacy reported more use of technology, and greater interest in using technologies. Participants of White (vs. non-White) race reported more use of internet and email but less interest in future use of mHealth. Younger age, higher annual income, and greater disease self-efficacy were associated with adequate eHealth literacy. Three themes regarding interest in using digital and mHealth technologies emerged: willingness, concerns, and barriers. LIMITATIONS Residual confounding, ascertainment bias. CONCLUSIONS Many individuals with CKD currently use the internet and smartphones and are interested in using mHealth in the future, but few use mHealth apps or have adequate eHealth literacy. mHealth technologies present an opportunity to engage individuals with CKD, especially members of racial or ethnic minority groups because those groups reported greater interest in using mHealth technology than the nonminority population. Further research is needed to identify strategies to overcome inadequate eHealth literacy.
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Affiliation(s)
- Sarah J Schrauben
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Lawrence Appel
- Johns Hopkins University School of Medicine and School of Public Health, Baltimore, MD
| | - Eleanor Rivera
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Claudia M Lora
- Department of Medicine, School of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James P Lash
- Department of Medicine, School of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jing Chen
- Tulane University School of Medicine, New Orleans, LA
| | - L Lee Hamm
- Tulane University School of Medicine, New Orleans, LA
| | - Jeffrey C Fink
- Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD
| | - Alan S Go
- Kaiser Permanentee Northern California, Oakland, CA
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Rajat Deo
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Laura M Dember
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Harold I Feldman
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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18
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Tome J, Ahmed S, Fagerlin A, Powell C, Mourao M, Chen E, Harrison S, Segal J, Abdel-Kader K, Nunes JW. Patient Electronic Health Record Portal Use and Patient-Centered Outcomes in CKD. Kidney Med 2021; 3:231-240.e1. [PMID: 33851118 PMCID: PMC8039427 DOI: 10.1016/j.xkme.2020.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Rationale & Objective Electronic health record portals are increasingly emphasized in chronic kidney disease (CKD). However, associations of portal use with clinical and patient-centered outcomes remain unknown. Study Design Cross-sectional survey (April 2015 to March 2018). Setting & Participants Nondialysis patients with CKD from nephrology clinics within 1 academic medical center. Exposures Patient demographics (age, sex, race, ethnicity, education, and income), kidney function. Outcomes Association between portal use as an outcome and exposures. Additionally, associations of portal use and patient demographics with 4 patient-centered outcomes (CKD-specific knowledge, stress, and 2 self-ratings of health). Analytic Approach Logistic regression to examine associations between patient portal use, demographics, and kidney function. Linear regression to examine associations between portal use and patient-centered outcomes. Results Of 245 participants, mean age was 60 ± 17 (SD) years, 182 (77%) were White, 121 (49%) were women, 230 (96%) had a high school education or higher, and 96 (45%) had <$50,000 annual income. Examining portal use, 159 (65%) used the portal as follows: checking laboratory test results, 157 (99%); managing appointments, 133 (84%); messaging providers, 131 (82%); viewing medical history, 127 (80%); reviewing educational resources, 113 (71%); and renewing prescriptions, 98 (62%). African Americans (OR, 0.34; 95% CI, 0.16-0.72 vs White patients), patients with less formal education (OR, 0.06; 95% CI, 0.01-0.36), and those with lower income (OR, 0.28; 95% CI, 0.13-0.60; and OR, 0.26; 95% CI, 0.12-0.54 comparing income < $25,000 and $25,000-$50,000, respectively, with ≥$50,000) had lower odds of using the portal. In adjusted analysis, only lower income predicted lower portal use. Examining patient-centered outcomes in univariable analysis, portal users had higher knowledge (β = 4.89; P = 0.02), higher ratings of current health (β = 0.28; P = 0.03), and lower CKD-related stress (β = -0.18; P = 0.05). In adjusted analysis, only patient demographics and/or kidney function remained independent predictors of patient-centered outcomes. Limitations Cross-sectional study design, cannot determine causality. Conclusions Interventions are needed to ensure that all patients have access to portals to mitigate disparities in care.
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Affiliation(s)
- June Tome
- University of Michigan, Ann Arbor, MI
| | | | - Angela Fagerlin
- University of Utah and Salt Lake City VA, Salt Lake City, UT
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Hussein WF, Bennett PN, Pace S, Chen S, Legg V, Atwal J, Sun S, Schiller B. The Mobile Health Readiness of People Receiving In-Center Hemodialysis and Home Dialysis. Clin J Am Soc Nephrol 2021; 16:98-106. [PMID: 33355235 PMCID: PMC7792646 DOI: 10.2215/cjn.11690720] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Mobile 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, & MEASUREMENTS A 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. RESULTS In 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. CONCLUSIONS The 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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Affiliation(s)
- Wael F. Hussein
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Paul N. Bennett
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Sloane Pace
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Shijie Chen
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Veronica Legg
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Jugjeet Atwal
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Sumi Sun
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California
| | - Brigitte Schiller
- Medical Clinical Affairs, Satellite Healthcare Inc., San Jose, California,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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20
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Yang FJ, Hou YH, Chang RE. The Impact of a Social Networking Service-Enhanced Smart Care Model on Stage 5 Chronic Kidney Disease: Quasi-Experimental Study. J Med Internet Res 2020; 22:e15565. [PMID: 32200348 PMCID: PMC7189249 DOI: 10.2196/15565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 01/30/2020] [Accepted: 03/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background Stage 5 chronic kidney disease (CKD) presents a high risk for dialysis initiation and for complications such as uremic encephalopathy, uremic symptoms, gastrointestinal bleeding, and infection. One of the most common barriers to health care for patients with stage 5 CKD is poor continuity of care due to unresolved communication gaps. Objective Our aim was to establish a powerful care model that includes the use of a social networking service (SNS) to improve care quality for patients with CKD and safely delay dialysis initiation. Methods We used a retrospective cohort of CKD patients aged 20-85 years who received care between 2007 and 2017 to evaluate the efficacy of incorporating an SNS into the health care system. In 2014, author F-JY, a nephrologist at the National Taiwan University Hospital Yunlin Branch, started to use an SNS app to connect with stage 5 CKD patients and their families. In cases of emergency, patients and families could quickly report any condition to F-JY. Using this app, F-JY helped facilitate productive interactions between these patients and the health care system. The intention was to safely delay the initiation of dialysis therapy. We divided patients into four groups: group 1 (G1) included patients at the study hospital during the 2007-2014 period who had contact only with nephrologists other than F-JY; group 2 (G2) included patients who visited F-JY during the 2007-2014 period before he began using the SNS app; group 3 (G3) included patients who visited nephrologists other than F-JY during the 2014-2017 period and had no interactions using the SNS; and group 4 (G4) included patients who visited F-JY during the 2014-2017 period and interacted with him using the SNS app. Results We recruited 209 patients with stage 5 CKD who had been enrolled in the study hospital’s CKD program between 2007 and 2017. Each of the four groups initiated dialysis at different times. Before adjusting for baseline estimated glomerular filtration rate (eGFR), the G4 patients had a longer time to dialysis (mean 761.7 days, SD 616.2 days) than the other groups (G1: mean 403.6 days, SD 409.4 days, P=.011 for G4 vs G1; G2: 394.8 days, SD 318.8 days, P=.04; G3: 369.1 days, SD 330.8 days, P=.049). After adjusting for baseline eGFR, G4 had a longer duration for each eGFR drop (mean 84.8 days, SD 65.1 days) than the other groups (G1: mean 43.5 days, SD 45.4 days, P=.005; G2: mean 42.5 days, SD 26.5 days, P=.03; G3: mean 3.8.7 days, SD 33.5 days, P=.002). Conclusions The use of an SNS app between patients with stage 5 CKD and their physicians can reduce the communication gap between them and create benefits such as prolonging time-to-dialysis initiation. The role of SNSs and associated care models should be further investigated in a larger population.
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Affiliation(s)
- Feng-Jung Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Hui Hou
- Department Health Industry Management, School of Healthcare Management, Kainan University, Taoyuan, Taiwan
| | - Ray-E Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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21
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Chaudhuri S, Han H, Muchiutti C, Ryter J, Reviriego-Mendoza M, Maddux D, Larkin JW, Usvyat LA, Chatoth D, Kooman JP, Maddux FW. Remote Treatment Monitoring on Hospitalization and Technique Failure Rates in Peritoneal Dialysis Patients. KIDNEY360 2020; 1:191-202. [PMID: 35368632 PMCID: PMC8809254 DOI: 10.34067/kid.0000302019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/28/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND An integrated kidney disease healthcare company implemented a peritoneal dialysis (PD) remote treatment monitoring (RTM) application in 2016. We assessed if RTM utilization associates with hospitalization and technique failure rates. METHODS We used data from adult (age ≥18 years) patients on PD treated from October 2016 through May 2019 who registered online for the RTM. Patients were classified by RTM use during a 30-day baseline after registration. Groups were: nonusers (never entered data), moderate users (entered one to 15 treatments), and frequent users (entered >15 treatments). We compared hospital admission/day and sustained technique failure (required >6 consecutive weeks of hemodialysis) rates over 3, 6, 9, and 12 months of follow-up using Poisson and Cox models adjusted for patient/clinical characteristics. RESULTS Among 6343 patients, 65% were nonusers, 11% were moderate users, and 25% were frequent users. Incidence rate of hospital admission was 22% (incidence rate ratio [IRR]=0.78; P=0.002), 24% (IRR=0.76; P<0.001), 23% (IRR=0.77; P≤0.001), and 26% (IRR=0.74; P≤0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Incidence rate of hospital days was 38% (IRR=0.62; P=0.013), 35% (IRR=0.65; P=0.001), 34% (IRR=0.66; P≤0.001), and 32% (IRR=0.68; P<0.001) lower in frequent users after 3, 6, 9, and 12 months, respectively, versus nonusers. Sustained technique failure risk at 3, 6, 9, and 12 months was 33% (hazard ratio [HR]=0.67; P=0.020), 31% (HR=0.69; P=0.003), 31% (HR=0.69; P=0.001), and 27% (HR=0.73; P=0.001) lower, respectively, in frequent users versus nonusers. Among a subgroup of survivors of the 12-month follow-up, sustained technique failure risk was 26% (HR=0.74; P=0.023) and 21% (HR=0.79; P=0.054) lower after 9 and 12 months, respectively, in frequent users versus nonusers. CONCLUSIONS Our findings suggest frequent use of an RTM application associates with less hospital admissions, shorter hospital length of stay, and lower technique failure rates. Adoption of RTM applications may have the potential to improve timely identification/intervention of complications.
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Affiliation(s)
- Sheetal Chaudhuri
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
- Maastricht University Medical Center, Maastricht, The Netherlands; and
| | - Hao Han
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | | | - Jessica Ryter
- Fresenius Medical Care North America, Waltham, Massachusetts
| | | | - Dugan Maddux
- Fresenius Medical Care North America, Waltham, Massachusetts
| | - John W. Larkin
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | - Len A. Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | - Dinesh Chatoth
- Fresenius Medical Care North America, Waltham, Massachusetts
| | - Jeroen P. Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands; and
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22
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Van Biesen W, Jha V, Abu-Alfa AK, Andreoli SP, Ashuntantang G, Bernieh B, Brown E, Chen Y, Coppo R, Couchoud C, Cullis B, Douthat W, Eke FU, Hemmelgarn B, Hou FF, Levin NW, Luyckx VA, Morton RL, Moosa MR, Murtagh FE, Richards M, Rondeau E, Schneditz D, Shah KD, Tesar V, Yeates K, Garcia Garcia G. Considerations on equity in management of end-stage kidney disease in low- and middle-income countries. Kidney Int Suppl (2011) 2020; 10:e63-e71. [PMID: 32149010 PMCID: PMC7031686 DOI: 10.1016/j.kisu.2019.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation of kidney replacement therapy (KRT) programs must address issues of availability, affordability, and acceptability. The major structural factors that impact equity in KRT in different countries are the organization of health systems, overall health care spending, funding and delivery models, and nature of KRT prioritization (transplantation, hemodialysis or peritoneal dialysis, and conservative care). Implementation of KRT programs has the potential to exacerbate inequity unless equity is deliberately addressed. In this review, we summarize discussions on equitable provision of KRT in low- and middle-income countries and suggest areas for future research.
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Affiliation(s)
- Wim Van Biesen
- Nephrology Department, Ghent University Hospital, Ghent, Belgium
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Ali K. Abu-Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sharon P. Andreoli
- Department of Pediatrics, Pediatric Nephrology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde I, Cameroon
| | - Bassam Bernieh
- Home Hemodialysis for Home Dialysis, Al Ain, United Arab Emirates
- The Heart Medical Center, Al Ain, United Arab Emirates
| | - Edwina Brown
- Imperial College Healthcare National Health Service Trust, London, UK
| | - Yuqing Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Cecile Couchoud
- French Renal Epidemiology and Information Network (REIN) Registry, Biomedicine Agency, Paris, France
| | - Brett Cullis
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa
| | - Walter Douthat
- Hospital Privado-Universitario de Cordoba and Instituto Universitario de Ciencias Biomédicas, Cordoba, Argentina
| | - Felicia U. Eke
- Department of Pediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Brenda Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nathan W. Levin
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Valerie A. Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Mohammed Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Fliss E.M. Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Daniel Schneditz
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | | | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
| | - Karen Yeates
- Division of Nephrology, Queen’s University, Kingston, Ontario, Canada
| | - Guillermo Garcia Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico
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Putri IRP, Nursalam N, Kurniawati ND. Information Technology-based Interventions for Health Care Support in Patients with Chronic Kidney Disease: A Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Self-management and support in managing therapeutic regimens is very important for patients with CKD. Information technology-based interventions are increasingly being used to support the self-management of patients with CKD. This study aimed to conduct a systematic review to evaluate information technology-based interventions in relation to the support of the health management of patients with CKD.Method: We conducted a systematic review using electronic databases (Scopus, Science Direct, ProQuest) limited to the last 8 years from 2010 to 2018 with the relevant keywords. The studies included used RCT, pilot and case-control methods focusing on patients with CKD stage 1-5 and that reported on at least one outcome from the health management of patients with CKD.Result: Out of the 7.852 studies taken, 13 studies fulfilled the inclusion criteria. The interventions in this systematic review are multifaceted, including smartphone/PDA (6/13), telematics devices (2/13), internet/web (3/13) and a combination of several interventions (2 studies). In total, 12 (92%) out of the 13 studies showed a positive outcome from the intervention, 7 studies showed improved outcomes in the clinical points, 3 studies had improved adherence and 2 studies improved knowledge.Conclusion: This evidence indicates the potential of IT-based interventions (i.e. smartphone/PDA, computer, internet/web, telematic device) to support the health management of patients with CKD. The variety of interventions in this systematic review requires further research on which interventions are best applied.
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Dawson AZ, Walker RJ, Campbell JA, Davidson TM, Egede LE. Telehealth and indigenous populations around the world: a systematic review on current modalities for physical and mental health. Mhealth 2020; 6:30. [PMID: 32632368 PMCID: PMC7327286 DOI: 10.21037/mhealth.2019.12.03] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022] Open
Abstract
Approximately 370-500 million Indigenous people live worldwide. While Indigenous peoples make up only 5% of the world's population, they account for 15% of the extreme poor and have life expectancy that is 20 years shorter than that of non-Indigenous people. Access to healthcare has been identified as an important social determinant of health and key driver of health outcomes. Indigenous populations often face barriers to accessing healthcare including living in remote areas, lacking financial resources, and having cultural differences. Telehealth, the utililzation of any synchronous modality, including phone, video, or teleconferencing technology used to support the provision of long-distance health care and health education, is a feasible and cost-effective treatment delivery mechanism that has successfully addressed access barriers faced by vulnerable populations globally, however, few studies have included indigenous populations and the application of this technology to improve physical and mental health outcomes. This systematic review aims to identify trials that were conducted among Indigenous adults, and to summarize the components of interventions that have been found to effectively improve the health of Indigenous peoples. The PRISMA guidelines for reporting of systematic reviews were followed in preparing this manuscript. Studies were identified by searching PubMed, Scopus, and PsychInfo databases for clinical trial articles on Indigenous peoples and mental and physical health, published between January 1, 1998 and December 31, 2018. Eligibility criteria for determining studies to include in the analysis were as follows: (I) ≥18 years of age; (II) indigenous peoples; (III) any technology-based intervention; (IV) studies included at least one of the following mental health (depression, post-traumatic stress disorder, suicide) and physical health (mortality, blood pressure, hemoglobin A1C, cholesterol, quality of life) outcomes; (V) clinical trials. A total of 2,662 articles were identified and six were included in the final review based on pre-specified eligibility criteria. Three were conducted in the United States, one study was conducted in Canada, and two were conducted in New Zealand. Study sample sizes ranged from 20 to 762, intervention delivery times ranged from three to 20 months and utilized telephone, internet and SMS messaging as the type of technology. There is a paucity of evidence on the use of telehealth programs to increase access to chronic disease programs in Indigenous populations. This review highlights the importance of culturally tailoring programs despite the modality in which they are delivered, and recommends telephone-based delivery facilitated by a trained health professional. Telehealth has great promise for meeting the health needs of highly marginalized Indigenous populations around the world, however, at this point more research is needed to understand how best to structure and deliver these programs for maximum effect.
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Affiliation(s)
- Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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25
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Citarda S, Camarroque AL, Seret G, De Laforcade L, Bureau C, Caillette-Beaudoin A, Bertocchio JP. [e-Health in nephrology: 1 st French survey on telenephrology]. Nephrol Ther 2019; 15:452-460. [PMID: 31640944 DOI: 10.1016/j.nephro.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/23/2019] [Indexed: 11/27/2022]
Abstract
The number of new patients with chronic kidney diseases strongly increases while the one of nephrologists does not: this is developing new challenges, in which e-health will take a special part. This field is poorly investigated: so, we developed a dedicated survey. Telenephrology is a new approach that includes all what nephrologists can do in their routine practice: especially, telehealth with teleconsulting, telesurvey, and helpline. We also studied their relationship with m-health. The questionnaire was developed and validated by members from the Club des Jeunes Néphrologues and the Société Francophone de Néphrologie, Dialyse et Transplantation: it was then broadcast to all french nephrologists, thru web media. From June to July, 2017, we collected 175 answers: they represented all kinds of practices of the profession. Results show that French nephrologists are connected: most of them are present on social network(s) and/or uses connected objects, mostly for personal reasons. They communicate a lot, between them and/or with patients, mainly via email. Computerized medical records are mostly used in the follow-up of patients on renal dialysis or with chronic kidney diseases. Most of French nephrologists are satisfied by telenephrology but there are still obstacles to its deployment: mainly, technical, administrative, and/or billing difficulties. All should be taken into account to help telenephrology developing. In conclusion, French nephrologists are yet connected but they really need more help again to face new challenges raised by e-health.
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Affiliation(s)
- Salvatore Citarda
- Club des jeunes néphrologues, 2, rue du bourg l'abbé, 75003 Paris, France; Calydial, Centre Associatif LYonnais de DIALyse, 51, rue Yvours, 69540 Irigny, France
| | - Anne-Laure Camarroque
- Calydial, Centre Associatif LYonnais de DIALyse, 51, rue Yvours, 69540 Irigny, France
| | - Guillaume Seret
- Club des jeunes néphrologues, 2, rue du bourg l'abbé, 75003 Paris, France; Echo, expansion des centres d'hémodialyse de l'Ouest, 34, rue de Guetteloup, 72000 Le Mans, France
| | - Louis De Laforcade
- Club des jeunes néphrologues, 2, rue du bourg l'abbé, 75003 Paris, France; Service de néphrologie, centre hospitalier Pierre-Oudot-Bourgoin-Jallieu, 38300 Bourgoin-Jallieu, France
| | - Côme Bureau
- Club des jeunes néphrologues, 2, rue du bourg l'abbé, 75003 Paris, France; Service de réanimation, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | | | - Jean-Philippe Bertocchio
- Club des jeunes néphrologues, 2, rue du bourg l'abbé, 75003 Paris, France; Service explorations fonctionnelles rénales et métaboliques, hôpital Européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris, France; Faculté de médecine, université Paris-Descartes, 75005 Paris, France.
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- Club des jeunes néphrologues, 2, rue du bourg l'abbé, 75003 Paris, France
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Lin YH, Guo JL, Hsu HP, Yang LS, Fu YL, Huang CM. Does "hospital loyalty" matter? Factors related to the intention of using a mobile app. Patient Prefer Adherence 2019; 13:1283-1294. [PMID: 31534315 PMCID: PMC6682323 DOI: 10.2147/ppa.s207031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/21/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to explore the association between hospital loyalty, perceived usefulness of a mobile app, perceived ease of use of that mobile app, and satisfaction with the app's use as well as predicting patients' intended use of the app. PATIENTS AND METHODS Purposive sampling was adopted in a cross-sectional survey. The participants were outpatients at the traditional Chinese medicine departments of three hospitals in northern Taiwan (n=125). The self-report questionnaire comprised information about sociodemographics and scales related to hospital loyalty, perceived usefulness of the mobile app, its perceived ease of use, satisfaction with its use, and its usage intention. The data were analyzed using structural equation modeling. RESULTS The four factors explained 70% variance in usage intention. The perceived usefulness of the mobile app directly and indirectly affects their usage intention, but its perceived ease of use had only indirect effects on the usage intention. Perceived usefulness and perceived ease of use influence the usage intention through satisfaction. The women's hospital loyalty does not directly affect the usage intention of the mobile app, but indirectly affects it through perceived usefulness and perceived ease of use of the mobile app. CONCLUSION Intended use of the app by women is mainly related to their experience of which is usefulness, ease of use and satisfaction of service are the most important factors contributing to continuous use. Hospital loyalty does not directly affect intention to use as expected. The influence of loyalty must be related to the patients' perception of the product, in terms of usefulness, ease to use, and satisfaction. The finding is helpful to understand patients' preference and support their behavioral adherence.
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Affiliation(s)
- Yun-Hsuan Lin
- Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan
- Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsiao-Pei Hsu
- Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Li-Shu Yang
- Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ya-Lin Fu
- Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
- Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
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27
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Doyle N, Murphy M, Brennan L, Waugh A, McCann M, Mellotte G. The “
Mikidney
” smartphone app pilot study: Empowering patients with Chronic Kidney Disease. J Ren Care 2019; 45:133-140. [DOI: 10.1111/jorc.12281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/05/2019] [Accepted: 03/17/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Nuala Doyle
- Renal UnitSt. James's Hospital Dublin Ireland
| | | | - Laura Brennan
- Department of Clinical NutritionSt. James's Hospital Dublin Ireland
| | - Alice Waugh
- Department of PhysiotherapySt. James's Hospital Dublin Ireland
| | - Margaret McCann
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and MidwiferyTrinity College Dublin Dublin Ireland
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Dubin R, Rubinsky A. A Digital Modality Decision Program for Patients With Advanced Chronic Kidney Disease. JMIR Form Res 2019; 3:e12528. [PMID: 30724735 PMCID: PMC6381409 DOI: 10.2196/12528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patient education regarding end-stage renal disease (ESRD) has the potential to reduce adverse outcomes and increase the use of in-home renal replacement therapies. OBJECTIVE This study aimed to investigate whether an online, easily scalable education program can improve patient knowledge and facilitate decision making regarding renal replacement therapy options. METHODS We developed a 4-week online, digital educational program that included written information, short videos, and social networking features. Topics included kidney transplant, conservative management, peritoneal dialysis, in-home hemodialysis, and in-center hemodialysis. We recruited patients with advanced chronic kidney disease (stage IV and V) to enroll in the online program, and we evaluated the feasibility and potential impact of the digital program by conducting pre- and postintervention surveys in areas of knowledge, self-efficacy, and choice of ESRD care. RESULTS Of the 98 individuals found to be eligible for the study, 28 enrolled and signed the consent form and 25 completed the study. The average age of participants was 65 (SD 15) years, and the average estimated glomerular filtration rate was 21 (SD 6) ml/min/1.73 m2. Before the intervention, 32% of patients (8/25) were unable to make an ESRD treatment choice; after the intervention, all 25 participants made a choice. The proportion of persons who selected kidney transplant as the first choice increased from 48% (12/25) at intake to 84% (21/25) after program completion (P=.01). Among modality options, peritoneal dialysis increased as the first choice for 4/25 (16%) patients at intake to 13/25 (52%) after program completion (P=.004). We also observed significant increases in knowledge score (from 65 [SD 56] to 83 [SD 14]; P<.001) and self-efficacy score (from 3.7 [SD 0.7] to 4.3 [SD 0.5]; P<.001). CONCLUSIONS Implementation of a digital ESRD education program is feasible and may facilitate patients' decisions about renal replacement therapies. Larger studies are necessary to understand whether the program affects clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02976220; https://clinicaltrials.gov/ct2/show/NCT02976220.
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Affiliation(s)
- Ruth Dubin
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States.,University California San Francisco, San Francisco, CA, United States
| | - Anna Rubinsky
- Kidney Health Research Collaborative, University of California San Francisco / San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
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Chudy-Onwugaje K, Abutaleb A, Buchwald A, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada S, Russman K, Horst S, Beaulieu D, Quinn C, Jambaulikar G, Cross RK. Age Modifies the Association Between Depressive Symptoms and Adherence to Self-Testing With Telemedicine in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2648-2654. [PMID: 29846623 PMCID: PMC6262196 DOI: 10.1093/ibd/izy194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Depression is common in patients with inflammatory bowel disease (IBD) and is known to be associated with poor adherence in the usual care setting. In the last decade, there has been an increase in the use of information technology (IT) for the delivery of IBD care, but the association between depressive symptoms (DS) and adherence to self-testing in this context is not known. We aimed to investigate this association among IBD patients managed via a text messaging-based telemedicine system. METHODS This was a prospective study of participants in the 2 intervention arms of the Telemedicine for Patients with IBD (TELE-IBD) trial. Depressive symptoms were measured at baseline, and then participants received periodic text messages to initiate IBD-specific self-testing. Treatment plans were similarly conveyed, and adherence to self-testing was evaluated at the end of 1 year. Regression analyses were performed, and age-stratified models were constructed to evaluate for effect modification. RESULTS Of the 193 study participants, 48% had DS at baseline. Overall, there was no significant association between DS and adherence to self-testing. However, upon stratification by age, adherence increased with depressive symptoms in those that were 40 years and younger (P = 0.02), but there was no association between depressive symptoms and adherence in the older group (P = 0.53). CONCLUSIONS Younger IBD patients with DS have high adherence when managed in a text messaging-based telemedicine program. Telemedicine interventions have the potential to improve health outcomes in this demographic-a group that is often thought to be difficult to manage due to nonadherence.
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Affiliation(s)
| | - Ameer Abutaleb
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Andrea Buchwald
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | - Miguel Regueiro
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Schwartz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | - Leyla Ghazi
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Sandra Quezada
- Division of Gastroenterology and Hepatology, Department of Medicine
| | | | - Sara Horst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Dawn Beaulieu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Charlene Quinn
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
| | | | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine,Address correspondence to: Raymond K. Cross, MD, MS, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201 ()
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Cherrez-Ojeda I, Felix M, Mata VL, Vanegas E, Gavilanes AWD, Chedraui P, Simancas-Racines D, Calderon JC, Ortiz F, Blum G, Plua A, Gonzalez G, Moscoso G, Morquecho W. Preferences of ICT among Patients with Chronic Kidney Disease Undergoing Hemodialysis: An Ecuadorian Cross-Sectional Study. Healthc Inform Res 2018; 24:292-299. [PMID: 30443417 PMCID: PMC6230525 DOI: 10.4258/hir.2018.24.4.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of the present study was to assess the frequency of use, and preferences regarding information and communication technologies (ICTs) among Ecuadorian patients with chronic kidney disease (CKD) undergoing hemodialysis. Methods We conducted an anonymous cross-sectional survey-based study from January 2016 to April 2017, involving 393 patients with end-stage renal disease from 9 hemodialysis centers, in which they rated their use and preferences of various ICTs through a modified version of the Michigan Questionnaire. The questionnaire collected information regarding demographics, patients' interest in obtaining health-related information through ICTs, and interest in using ICTs as a potential way to communicate with their healthcare providers. A chi-square test for association and adjusted regression analyses were performed. Results Among all patients who participated, 64.3% reported owning a cellphone, with less than a third reporting active Internet connection. The most used ICT for obtaining information about CKD and/or hemodialysis was web-based Internet, followed by YouTube. SMS was rated the highest to receive and seek health-related information, followed by Facebook. Younger age and higher levels of education were associated with a higher overall usage of ICTs. Finally, more than half of the patients reported interest in using WhatsApp for communicating with their healthcare providers. Conclusions Understanding the preferences of ICTs among patients with CKD undergoing hemodialysis could help to improve their outcomes through the potential uses and benefits of ICTs. Further research is needed to assess their role in improving the care of patients with chronic diseases.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Valeria L Mata
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Antonio W D Gavilanes
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.,School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Daniel Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | | | - Fabian Ortiz
- Instituto Ecuatoriano de Diálisis y Trasplantes (IEDYT), Guayaquil, Ecuador.,Unidad de Diálisis del Norte (UNIDIAL), Guayaquil, Ecuador
| | - Guillermina Blum
- Centro de Diálisis de la Fundación Renal del Ecuador "Iñigo Alvarez de Toledo", Guayaquil, Ecuador
| | - Angela Plua
- Instituto del Riñón y Diálisis, MEDICDIAL S.A., Guayaquil, Ecuador
| | | | - Grace Moscoso
- Universidad Espíritu Santo, Samborondón, Ecuador.,Hospital Dr. Abel Gilbert Pontón, Guayaquil, Ecuador
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Chisholm-Burns MA, Spivey CA, Pickett LR. Health literacy in solid-organ transplantation: a model to improve understanding. Patient Prefer Adherence 2018; 12:2325-2338. [PMID: 30464420 PMCID: PMC6229143 DOI: 10.2147/ppa.s183092] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy. Based on the Paasche-Orlow and Wolf model of health literacy, the Health Literacy Model in Transplantation (HeaL-T) provides a foundation to visually demonstrate the relationships among variables associated with low health literacy and to develop evidence-based strategies to improve care. The model depicts a number of patient and healthcare level factors associated with health literacy, several of which have bi-directional or reciprocal relationships, including access and utilization of healthcare, provider-patient interaction, and self-management/adherence. The impact of these factors and their relationships to SOTR outcomes are reviewed. The HeaL-T represents an important step in developing holistic understanding of the complexity of health literacy in SOTRs and offers clinicians a base from which to design strategies to mitigate adverse health effects including increased hospitalizations, graft failure, and mortality.
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Affiliation(s)
| | - Christina A Spivey
- University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Memphis, TN, USA
| | - Logan R Pickett
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA,
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