Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Abstract

Background and objectives Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters.Design, setting, participants, & measurements We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. ResultsIn total, 47 patients (26 men; mean age =59 years old; 33% were $65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (.80% performed $80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, 23.4 mmHg; 95% confidence interval, 25.0 to 21.8 and diastolic BP, 22.1 mmHg; 95% confidence interval, 22.9 to 21.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged.Conclusions Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial.

Context-Aware Systems for Chronic Disease Patients: Scoping Review (Preprint)

“…One study was conducted in Canada [12], 2 were in the US [13,14], and 2 in Europe [15,16]. Most articles were published after 2010, except one [17].…”

“…Most articles were published after 2010, except one [17]. The health domains covered in the studies included asthma [13], cardiovascular disease [16], kidney disease [12], Parkinson's disease [17], diabetes [15], and mental health [14]. All included studies used quasi-experimental study designs to pilot test different context-aware systems.…”

“…Demographic information on participants was often missing and inconsistently reported. Specifically, age data was reported by three studies [12,14,17] and four studies reported sex data [12,14,15,17].…”

“…Two studies focused on indoor settings [13,17] and 4 studies involved both indoor and outdoor settings [12,[14][15][16].…”

“…Context was captured using sensors [12][13][14]16,17] and self-reports [12][13][14][15]. One particular study used ecological momentary assessment to capture self-reported data on social context, activity, and internal states (i.e.…”