Improving proteinuria screening with mailed smartphone urinalysis testing in previously unscreened patients with hypertension: a randomized controlled trial

Abstract

Background Proteinuria screening is recommended for patients with hypertension to screen for kidney disease and identify those at elevated risk for cardiovascular disease. However, screening rates among hypertensive patients are low. Home testing strategies may be useful in improving proteinuria screening adherence. Methods We conducted an individual-level, randomized trial at 55 primary care clinic sites in the Geisinger Health System to evaluate the effectiveness of a strategy using home smartphone urinalysis test (Dip.io) to complete proteinuria screening in previously unscreened non-diabetic patient portal users with hypertension. All patients received an educational letter and a standing urinalysis lab order, and then were randomized to control (usual care) or intervention. Intervention arm participants were invited to complete proteinuria screening with a mailed home smartphone urinalysis test. Co-primary outcomes were completion of proteinuria screening and number of albuminuria cases (albumin/creatinine ratio [ACR] ≥ 30 mg/g or protein/creatinine ratio ≥ 150 mg/g) at the end of 3 months. We also evaluated patient satisfaction with the home test, and compliance with recommendations for patients with newly detected albuminuria. Results A total of 999 patients were randomized to intervention or control. Out of 499 patients assigned to the intervention arm, 253 were reached by phone, and 69/97 (71.1%) consented patients completed the home test. Overall, the intervention increased proteinuria screening completion (28.9% vs. 18.0%; p < 0.001) with no effect on the number of albuminuria cases (4 vs. 4) although only 6/57 (10.5%) patients with trace or 1+ urine dipstick protein had a follow-up quantitative test. Among the 55 patients who completed a survey after the home test, 89% preferred testing at home rather than the physician’s office. Conclusions A strategy using a home urinalysis smartphone test increased proteinuria screening rates in previously unscreened patients with hypertension and may be useful in increasing rates of proteinuria screening compliance. Future studies should evaluate use of home testing kits to screen for and confirm albuminuria, and determine whether improving early detection of kidney disease can improve future kidney health. Trial registration Clinical Trial Registry: NCT03470701 (First posted 3/20/2018) https://clinicaltrials.gov/ct2/show/NCT03470701 . This study was retrospectively registered.

Affordable mobile microfluidic diagnostics: minimum requirements for smartphones and digital imaging for colorimetric and fluorometric anti-dengue and anti-SARS-CoV-2 antibody detection

“…Smartphones can digitally record, interpret and quantify many measurements that have previously relied on a laboratory instrument to analyse, or needed a human operator to interpret lines or colour change by eye and then manually record results. A wide spectrum of devices and bioassays have been read using smartphones 1 , including pH in clinical samples 2 immunoassays 3,4 , nucleic acid detection 5,6 , microbiology 7,8 , and paper devices including urine analysis dipsticks 9 or cholesterol test strips 10 . Smartphones offer a combination of three features in an accessible package: high performance camera, on-board computing power, and networking.…”

Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review

“…Tertiary prevention for chronic disease management was supported primarily by care access expansion [ 20 , 58 , 103 , 178 , 181 , 189 ], app-driven [ 35 , 64 , 140 , 149 , 176 , 249 ], and patient-centered [ 38 , 97 , 241 , 245 ] approaches. Overall, DHIs decreased disease severity and associated comorbidities; lowered the numbers of emergency department visits, hospitalizations, and 30-day readmissions; increased the receipt of follow-up care; improved medication adherence in the identified studies [ 20 , 35 , 58 , 64 , 97 , 103 , 149 , 176 , 199 , 245 , 249 ]; and improved the quality or effectiveness of health services by technology implementation [ 24 , 38 , 103 , 140 , 171 , 178 , 186 , 189 , 249 ]. Disease areas targeted by DHIs included diabetes [ 38 , 97 , 171 , 176 ], hypertension [ 97 , 140 , 149 ], asthma [ 103 , 181 , 186 ], obesity [ 35 , 171 ], cardiovascular disease [ 123 ], HIV [ 199 ], HCV [ 245 ], and hyperlipidemia [ 97 ].…”

“…Overall, DHIs decreased disease severity and associated comorbidities; lowered the numbers of emergency department visits, hospitalizations, and 30-day readmissions; increased the receipt of follow-up care; improved medication adherence in the identified studies [ 20 , 35 , 58 , 64 , 97 , 103 , 149 , 176 , 199 , 245 , 249 ]; and improved the quality or effectiveness of health services by technology implementation [ 24 , 38 , 103 , 140 , 171 , 178 , 186 , 189 , 249 ]. Disease areas targeted by DHIs included diabetes [ 38 , 97 , 171 , 176 ], hypertension [ 97 , 140 , 149 ], asthma [ 103 , 181 , 186 ], obesity [ 35 , 171 ], cardiovascular disease [ 123 ], HIV [ 199 ], HCV [ 245 ], and hyperlipidemia [ 97 ]. Management of behavioral health included smoking cessation support [ 75 , 171 , 189 ], promotion of physical activity [ 171 ], substance abuse management [ 99 , 185 ], and sexual health education [ 45 ] using mHealth technology.…”

Urine Tests for Diagnosis of Infectious Diseases and Antibiotic-Resistant Pathogens

“…With point-of-care testing attracting much attention in recent years, smartphone solutions can be a valuable tool in this regard. It can, for example, increase the compliance of populations with screening programs by offering easy and fast screening method [80]. Studies exploring the possibility of establishing a smartphone-based diagnostic platform for rapid detection of Zika, chikungunya, and dengue viruses showed valuable prospective [20].…”