Cost-effectiveness of home telemonitoring in chronic kidney disease patients at different stages by a pragmatic randomized controlled trial (eNephro): rationale and study design

Abstract

BackgroundHome telemonitoring has developed considerably over recent years in chronic diseases in order to improve communication between healthcare professionals and patients and to promote early detection of deteriorating health status. In the nephrology setting, home telemonitoring has been evaluated in home dialysis patients but data are scarce concerning chronic kidney disease (CKD) patients before and after renal replacement therapy. The eNephro study is designed to assess the cost effectiveness, clinical/biological impact, and patient perception of a home telemonitoring for CKD patients. Our purpose is to present the rationale, design and organisational aspects of this study.MethodseNephro is a pragmatic randomised controlled trial, comparing home telemonitoring versus usual care in three populations of CKD patients: stage 3B/4 (n = 320); stage 5D CKD on dialysis (n = 260); stage 5 T CKD treated with transplantation (n= 260). Five hospitals and three not-for-profit providers managing self-care dialysis situated in three administrative regions in France are participating. The trial began in December 2015, with a scheduled 12-month inclusion period and 12 months follow-up. Outcomes include clinical and biological data (e.g. blood pressure, haemoglobin) collected from patient records, perceived health status (e.g. health related quality of life) collected from self-administered questionnaires, and health expenditure data retrieved from the French health insurance database (SNIIRAM) using a probabilistic matching procedure.DiscussionThe hypothesis is that home telemonitoring enables better control of clinical and biological parameters as well as improved perceived health status. This better control should limit emergency consultations and hospitalisations leading to decreased healthcare expenditure, compensating for the financial investment due to the telemedicine system.Trial registrationThis study has been registered at ClinicalTrials.gov under NCT02082093 (date of registration: February 14, 2014).

Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study (Preprint)

“…[9] In our study, the orientation provided to patients and caregivers was short in nature with minimal training which may reflect a well-designed product. [28] Similar to other studies using virtual care solutions [4,29,30] the ongoing accessibility and support from the CKD clinic team and vendor that patients had was key to using the eQ Connect™. Having virtual care solutions that are complimentary to and integrated with existing models of care is essential for usability and acceptance of new technology to support self-management and adherence.…”

“…This finding exemplifies another human factor design principle around having an intuitive design that is embedded into existing care practices of patients and workflow of healthcare professionals [9,28,35,36] that should be less complicated and time demanding. [4] Other good design elements that emerged in a recent qualitative study include aesthetic appearance, practicality and ease of use, and supportive platforms to enable flow of data. [28] In addition to co-design locally using a patient-centric approach, our study further highlighted the need to deploy over time and ensure that the vendor has the capacity to scale up the virtual care solution.…”

“…[3] People with CKD experience challenges accessing kidney care due to limited healthcare resources, which is exacerbated by geographical barriers. [6][7][8] In this context, patients (and their family members) must travel long distances to obtain care, which adds stress, imposes additional costs and contributes to the poorer quality of care, [4] and in some situations, mortality. [5] Barriers to access kidney care and associated costs may worsen as the prevalence of CKD increases with the rising aging population with multiple comorbidities that will require multiple medications to treat.…”

“…[5] Barriers to access kidney care and associated costs may worsen as the prevalence of CKD increases with the rising aging population with multiple comorbidities that will require multiple medications to treat. [1,4] Alternate CKD care delivery models are needed to address these challenges faced by CKD patients to ensure more flexible, convenient person-centred care delivery models, particularly for those living in rural and remote locations. [9] Peritoneal dialysis (PD) is one strategy to mitigate challenges with accessing care for managing CKD and provide patient centric, effective, and efficient care.…”

Telemonitoring Devices and Systems: Current Status and Future Trends

“…Chronic kidney patients in the early stages of the disease may be asymptomatic, leading to a lack of demand for medical care. Timely care of these patients can lead to a reduction in morbidity, mortality, costs associated with the disease, as well as a reduction in the number of consultations required for the patient, as the responsiveness of health systems tends to decrease [26], [27].…”