A Research Protocol for Implementation and Evaluation of a Patient-Focused eHealth Intervention for Chronic Kidney Disease

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.

Community pharmacists’ perspectives on assessing kidney function and medication dosing for patients with advanced chronic kidney disease: A qualitative study using the theoretical domains framework

“…To our knowledge, no such tool or standards exist to support community pharmacists managing high-risk medications in individuals with CKD. 50-56…”

“…To our knowledge, no such tool or standards exist to support community pharmacists managing high-risk medications in individuals with CKD. [50][51][52][53][54][55][56] Under the TDFv2 social influences, collaboration and support were categories community pharmacists emphasized. These have been previously reported as facilitators of CKD care in community practices.…”

An eHealth self-management intervention for adults with chronic kidney disease, My Kidneys My Health: a mixed-methods study

“…are members of our research team and have been involved in all phases of this work. [10][11][12][13][18][19][20][21] For this study, our patient partners aided in the study design (i.e., determination of the outcomes), conduct (i.e., recruitment, interview guide and reviewing results) and targeted dissemination activities (i.e., patient forums, dissemination materials).…”

Implementation strategies for high impact nephrology trials: the end of the trial is just the beginning

“…Used in isolation, the top-down approach, which involves rigid adherence to scientifically robust protocols to produce an evidence base, may conflict with a bottom-up approach, which focuses on utility of the intervention to end-users. The integrated RE-AIM and CFIR framework approach has previously been successfully utilised J o u r n a l P r e -p r o o f 6 in other health settings 5,6 and has recently been identified as the planned approach for a multistage implementation and evaluation protocol of an electronic health self-management tool for kidney patients 7 . For RCTs in kidney disease, the integrated use of the two frameworks may allow a complementary top-down (RE-AIM), bottom-up (CFIR) approach to implementation that would enable researchers to strategically plan for implementation and impact measurement (Figure 2).…”