Impact of Telehealth Interventions on Processes and Quality of Care for Patients With ESRD

Abstract

Caring for patients with end-stage renal disease (ESRD) requiring dialysis is intensive and expensive. Telehealth may improve the access and efficiency of ESRD care. For this perspective, we systematically reviewed studies that examined the effectiveness of telehealth versus or in addition to usual care for ESRD management. 10 studies were identified, including 7 randomized trials and 3 cohort studies. Study populations, modes of delivery (including telephone, telemetry, or videoconferencing), and the outcomes evaluated varied substantially between studies. Two studies examined telehealth interventions versus standard ESRD care and demonstrated mixed results on processes of care, no differences in laboratory surrogate markers of ESRD care, and reduced or similar rates of hospitalization. Eight studies evaluated the addition of telehealth to usual care and demonstrated no significant improvements in processes of care or surrogate laboratory measures, variable impacts on hospitalization rates, and mixed impacts on some domains of quality of life, including improvement in mental health. Although potential benefits of telehealth in ESRD care have been reported, optimal designs for delivery and elements of care that may be improved through telehealth remain uncertain.

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

“…There have been two recent reviews which have explored the use of eHealth intervention within CKD more broadly. 43,44 Compared with these previous reviews, this study has included more studies (15 studies, in contrast to 4 studies 43 and 6 studies 44 ) and examined additional outcomes specific to PD patients. Nonetheless all the reviews conducted to date, including this one, have not identified any adverse effects associated with the use of eHealth interventions for patients on PD.…”

Coronavirus Disease 2019’s Shake-up of Telehealth Policy: Application of Kingdon’s Multiple Streams Framework

“…Specialties with evidence demonstrating telehealth effectiveness include oncology, diabetology (including diabetes education services), cardiology, nephrology, psychiatry and addiction services, primary care, geriatrics, and women’s health. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 For instance, DeNicola et al’s systematic review 17 of telehealth interventions in women’s services found improvements in rates of perinatal smoking cessation, breastfeeding and scheduling of office visits, and obstetric outcomes. For the common chronic disease state of obesity, Huang et al’s systematic review 18 found telemedicine visits to be an effective intervention in reducing body weight for patients with or without hypertension and diabetes.…”

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

“…Outcomes associated with PD include increased satisfaction [13], increased quality of life [15,16], and survival advantage, especially in the first few years of therapy [17-19], with decreased costs to the health care system [20]. Virtual care, often referred to as telehealth or telemedicine, is a rapidly evolving area where health care services are delivered, in part, through technology, including clinician-to-clinician, clinician-to-patient, and patient-to-mobile health technology communication that aims to enhance patients’ self-management of their disease in a home setting [4,17,20,21]. Technology includes remote monitoring [4,21,22], mobile phones [5,23], virtual wards [24], and Web-based eHealth portals [25].…”

“…Virtual care, often referred to as telehealth or telemedicine, is a rapidly evolving area where health care services are delivered, in part, through technology, including clinician-to-clinician, clinician-to-patient, and patient-to-mobile health technology communication that aims to enhance patients’ self-management of their disease in a home setting [4,17,20,21]. Technology includes remote monitoring [4,21,22], mobile phones [5,23], virtual wards [24], and Web-based eHealth portals [25]. Virtual care, coupled with PD, has the potential to improve access for CKD care for patients in their own homes [26-30].…”

“…To date, research in this area has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on the factors that lead to the success or failure in uptake and scalability of telehealth programs for the CKD population [21]. Gaining insight into this gap may yield useful knowledge in improving the uptake and scalability of the virtual care solution (ie, telehealth) that can be used to improve future implementation efforts and ultimately improve patient and health service utilization outcomes.…”