eHealth interventions to support patients in delivering and managing peritoneal dialysis at home: A systematic review

Abstract

Peritoneal dialysis (PD) requires patients to develop a variety of self-management skills in order to effectively deliver and manage their dialysis at home. eHealth interventions may provide patients with accessible information to develop the skills and knowledge they require to manage their treatment. This review aims to identify and evaluate ‘active’ eHealth interventions in supporting patients on PD. Six databases were included within the review using the terms Peritoneal Dialysis, eHealth, telemedicine and remote consultation. Studies which explored patients who were delivering PD, an intervention where the main component involved a digital device and required active engagement from patients were included. The primary outcomes examined were identified using the core outcomes recommended by the Standardised Outcomes in Nephrology in Peritoneal Dialysis initiative (PD infection, cardiovascular disease, mortality, PD failure and life participation). Hospitalisation rates were also considered as a primary outcome. Secondary outcomes included quality of life, patient skills, patient knowledge and satisfaction. Using the inclusion criteria, 15 studies (1334 participants) were included in the study. The effectiveness of eHealth interventions was mixed. Due to high heterogeneity, a meta-analysis was not possible, and quality of evidence was low. Risk of bias across the randomised studies was unclear but bias across non-randomised studies was identified as critical. There were no reported adverse effects of eHealth interventions within the included studies. Despite the high interest of eHealth interventions in PD, good quality evidence is needed to explore their effectiveness before a wider application of eHealth interventions.

Impact of telehealth interventions added to peritoneal dialysis-care: a systematic review

“…A similar review on e-health interventions in PD care was recently published by others [14]. That review included 15 studies, published between 1992 and 2018, representing 1343 patients receiving PD.…”

“…Despite the growing interest in the use of e-healthbased interventions in home-dialysis, both the reported interventions and studied outcomes are heterogeneous, thereby limiting evidence regarding effectiveness in terms of improvement of standardized clinical outcomes and associated impact on healthcare efficiency and economics [14]. Recently, the number of e-health initiatives and publications amplified, largely accelerated by the COVID-19 pandemic, resulting in seven new studies on this topic, representing 9377 patients receiving PD [15][16][17][18][19][20][21].…”

Management of peritoneal dialysis under COVID-19: The experience in Sichuan Province People’s Hospital, China

“… 19 Some studies reported the benefits of eHealth interventions in supporting patients on PD. 20 , 21 Considering the risks of traffic control, outpatient restrictions, and nosocomial infection during the outbreak, we encourage patients to stay at home rather than go to the hospital. We launched a follow-up and training plan through telehealth to improve the medical safety of patients during the pandemic period.…”

Exploring agreement and feasibility between virtual home visits and in-person home visits for peritoneal dialysis patients—a paired study

“…Despite eHealth interventions to support PD patients in the delivery and management of home care, evidence of effectiveness is limited [ 25 , 26 ]. In particular, unlike other chronic diseases, PD home visits cannot be fully evaluated by outcome indicators.…”