Virtual support for peritoneal dialysis at home

Objectives

• Support patients who self-manage their peritoneal dialysis (PD) at home, thereby reducing the attrition rate of patients who fail to continue home PD.
• Reduce hospitalizations and infection rates and increase quality of life.
• Support the Ontario Renal Network’s goal to increase the percentage of patients receiving home dialysis to 28% by 2019.
• As a program and randomized controlled trial (RCT), this intervention has the potential to improve clinical outcomes, quality of life, reduce the costs of dialysis to the health care system and ultimately empower patients to start and stay on peritoneal dialysis. The RCT is expected to be complete in December 2020.

Eligibility Criteria

1. Able to provide informed consent
2. Patient or primary caregiver able to read and speak English
3. Over 18 years of age
4. Patient on PD (Automated Peritoneal Dialysis/Continuous Ambulatory Peritoneal Dialysis) for at least three months
5. Patient or primary care giver cognitively and physically capable and willing to interact with a tablet computer and perform self-measurements (e.g. taking weight)

Model

Eligible patients are enrolled into the trial by a clinician at the participating Regional Renal Program sites and provided with an iPad loaded with a remote telehome monitoring system. This system enables up-to-date data transmission and digital interaction between the patients at home and their health care team. The tool provides an easier way for patients to communicate with their health care providers, track their treatment and supplies, and receive training and self-management support. For providers, this program delivers real-time patient data and an efficient way to keep track of patients progress and trends that can indicate when further intervention is required.

Technology Type:
Patient Application:

• Communication (video, messaging and images)
• Treatment tracking
• Supply tracking
• Appointment reminders
• Educational content

Clinical Application: Ability to view the above-noted patient information and trending reports

Outcomes

• The RCT will determine the impact of the intervention on patients’ clinical outcomes and quality of life, costs of dialysis to the health care system and the attrition rate (ie. are patients empowered to start and stay on peritoneal dialysis at home)
• Patients enrolled in the intervention arm of the study are followed for one year.
  • 100% of the patients who have completed their study period have chosen to continue using this technology at the one-year mark.
  • 95% of patients reported that they feel better supported by their nurses using eQ Connect (Source: Impact Summary of eQ Connect in PD by eQOL)
• The program enables the tracking and auditing of supplies, and early-stage analysis indicated a supply cost savings of ~$145 per patient per month (~$1,740/patient/year) (Source: Impact Summary of eQ Connect in PD by eQOL)

Change Required to Support the Model

The research team felt that support and buy-in from the administration for this model was necessary. There was an initial increase in nursing burden with nurse education and the alignment of clinical pathways to nursing workflows. However, the benefits of the model were quickly realized; the ability to simply check on the patient’s data and observe trends allowed clinicians to proactively identify changes in the patient’s condition and act accordingly. Daily review of patient data saved not only clinical and patient time, but also ensured patients ordered and received the right supplies. New funding models such as bundled care have the potential to enable this care model to scale rapidly.

Adoption Rate

More than 240 patients have completed the trial, and 430 patients have been enrolled.

Over 4,500 messages have been sent between patient and the health care team.

Over 1,000 supply orders have been processed.

Disclaimer

OTN is an independent, not-for-profit organization funded by the Government of Ontario. The views expressed here are the views of OTN, or the respective authors if a third-party, and do not necessarily reflect those of the Province. For further information, please note the Proprietary Rights detailed within the OTN Terms of Service available at https://otn.stagingotn.ca/terms-conditions/