NE PHROLOGY
people to conduct their lives as normal. Notwithstanding this, it has been standard practice to schedule regular on-site hospital reviews in the absence of any apparent problem. Although the main purpose of these visits is to monitor renal function (i.e. view the latest blood tests result and check the blood pressure), it has been assumed that it serves other useful purposes; patients value the reassurance they gain from physically seeing their doctor and clinicians need their patients’ presence in order to identify problems which are not otherwise apparent. But is this really the case?
In 2019, such routine monitoring visits (four or fewer visits per year) accounted for about 85% of clinic attendances in our department. Because they were scheduled months in advance, they were unlikely to be responsive to the needs of the patients – there was little chance of an appointment coinciding with the onset of a new problem. If an issue requiring specialist input arose between visits, the patient needed an additional unscheduled appointment, for which there was seldom capacity. Clinics became overbooked with the result that many people attending routinely, with no apparent problem, went to considerable inconvenience (missing work, travelling, parking etc.) to attend hospital appointments, only to wait an unconscionable length of time for a brief review of blood pressure and pathology results along with an exchange of best wishes. Before the COVID-19 pandemic, we
surveyed patients attending these routine clinics. New transplant recipients told us that they spent an average of five hours (door-to-door) attending a clinic visit, only 15 minutes of which was face-to-face with a clinician. Most CKD patients (55%) expressed the view that, when they were well, routine face-to-face appointments were not a good use of their time or that of the clinical team. Presented with various
100 patients took part in the pilot
l 26 years to 82 years mean age of 55 years
l 53% transplant 38% nephrology 7% advanced kidney disease
40% 3% 30%
options for monitoring their kidney function (including clinic attendance) 75% of the surveyed patients expressed the view that oversight could be better delivered remotely using their home computer.
MyRenalCare: what it is and what it does. MyRenalCare is a web-based application which has been designed to promote remote monitoring and communication between the specialist centre and the patient in order to reduce face-to-face consultations. It builds a health record, stored in the cloud, which is readily accessible by the patient via the internet and engages them in their own care (self-monitoring and recording of blood pressure, weight and symptom reporting). The application was designed to enable consultations to be delivered via a computer or smartphone without requirement for any other contact: a ‘virtual consultation’. When the review is due, the application delivers a reminder to the patient by e-mail, prompting him or her to arrange a blood test at a time and site convenient for them (usually the GP or local hospital). Using the application, the patient notifies the clinician when the blood test has been performed. The clinician reviews all the results, including patient-entered BP, weight and symptom report and uses these to make a clinical judgement remotely. The clinician then enters a clinical note onto the system, which is fed back to the patient. If an issue requiring face-to-face or telephone contact is identified, the clinician can arrange this. If all is well, the clinician simply enters a suggested date of the next blood test or routine review by entering this into the patient’s on-line diary. Each routine virtual consultation can be
performed without the clinician or patient needing to be available to interact at a scheduled time or date. If a direct interaction
I feel that I am much more involved in managing my health.
I feel that I am slightly more involved in managing my health.
27%
57% reported being more involved in their care while using remote monitoring at the Wessex Kidney Centre
I feel as involved in managing my health as I always have.
I feel that I am less involved in managing my health.
Figure 1 How has your involvement in managing your renal health changed since using the app?
32 l
WWW.CLINICALSERVICESJOURNAL.COM
is required by the patient, the platform has been designed with the facility for patients to request a face-to-face or phone consultations, thus empowering them to take an active role in their care.
The criteria for offering a patient the
opportunity to use web-based remote monitoring were few; patients were required to have access to the internet, to possess an internet-enabled device and to be willing to try the technology. If, after learning more about the application, the patient wished to try it, they were consented and given login details to MyRenalCare, along with instructions detailing how to use the application.
The patients’ experience The system allowed clinical observations and symptom reports to be uploaded quickly and easily by the patient at any time with little intrusion into their daily activities. Patients were notified of test results and the clinical decisions made by their specialist within a day or two. Removing the need for a scheduled interaction (either face-to-face, by phone or via video link) at a particular time, on a particular day introduced a new flexibility into their care, thus reducing the burden of routine monitoring. Furthermore, they had the reassurance of knowing that clinical oversight was being delivered by their own specialist, who was named on their record at each interaction.
One hundred and eight patients (mean age 55 years, range 26-82 years) used our web-based platform for routine monitoring. We undertook a survey of their experiences over a six-month period. Ninety-three percent found the platform was easy to use and 82% felt that, when well, monitoring of their kidney condition was better done using our digital health platform with fewer face-to-face clinics. Patients were asked to estimate how much time they saved undertaking a virtual consultation compared with a traditional clinic attendance. 33% of respondents saved 30-60 minutes, 43% saved 60-120 minutes and 16% saved more than 120 minutes. 97% of respondents stated that they would recommend web-based remote monitoring to other renal patients.
During the six months of observation,
no face-to-face clinics were required. A follow-up telephone call was made (either at the request of the patient or as a clinical decision) after 35% of the reviews, but the remaining 65% were undertaken solely via the application.
The clinician’s experience Virtual consultations were more time-efficient for the clinician. Like the patients, clinicians were not restricted to a scheduled interaction at a given time or place. The process of reviewing the information on a patient’s record and entering a clinical note typically
FEBRUARY 2021
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72
