Pilot health technology assessment study: organizational and economic impact of remote monitoring system for home automated peritoneal dialysis

Abstract

Purpose Follow-up of automated peritoneal dialysis (APD) has been improved by data transmission by cellular modem and internet cloud. With the new remote patient monitoring (RPM) technology, clinical control and prescription of dialysis are performed by software (Baxter Claria-Sharesource), which allows the center to access home operational data. The objective of this pilot study was to determine the impact of RPM compared to traditional technology, in clinical, organizational, social, and economic terms in a single center. Methods We studied 21 prevalent APD patients aged 69 ± 13 years, on dialysis for a median of 9 months, for a period of 6 months with the traditional technology and 6 months with the new technology. A relevant portion of patients lived in mountainous or hilly areas. ResultsOur study shows more proactive calls from the center to patients after the consultation of RPM software, reduction of calls from patients and caregivers, early detection of clinical problems, a significant reduction of unscheduled visits, and a not significant reduction of hospitalizations. The analysis also highlighted how the RPM system lead to relevant economic savings, which for the health system have been calculated € 335 (mean per patient-month). With the social costs represented by the waste of time of the patient and the caregiver, we calculated € 685 (mean per patient-month). Conclusion In our pilot report, the RPM system allowed the accurate assessment of daily APD sessions to suggest significative organizational and economic advantages, and both patients and healthcare providers reported good subjective experiences in terms of safety and quality of follow-up.

Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis

“…It has been reported that in the early stage of dialysis, the survival rate of PD patients is better than that of HD patients [ 6 ]. Other studies show that the survival rates of the two groups of dialysis patients are similar [ 7 ].…”

Telehealth strategies in the care of people with chronic kidney disease: integrative review

“… Multi-professional teleconsultation by video calls, photos, and text messages. There were no statistical differences in the rates of peritonitis, hospitalization, and transfer to HD ¶ compared to care absent from telemedicine./ Level IV Amici, et al, 2021 / International Urology and Nephrology/ Italy Quasi-experimental/ Home-based / Automated PD †† Determine the impact of telemedicine technology with RM ‡ compared to traditional technology on organizational, social, and economic aspects. Automated PD †† RM ‡ and telephone follow-up.…”

“…The multimodality category frames the studies that used, with the same relevance, diversified and joint TH strategies. As an example, there are teleconsultation and text messages ( 24 , 26 , 38 ) , PD monitoring with telephone contact ( 28 , 60 ) , blood pressure monitoring with app ( 35 ) and blood pressure monitoring with an online platform for data collection ( 61 ) . Regarding the scenarios adopted, the home environment is presented in four studies ( 28 , 35 , 60 - 61 ) , the dialysis clinics in two ( 24 , 38 ) and the outpatient clinic in one ( 26 ) .…”

Delivering Person-Centered Peritoneal Dialysis

“…51 Indeed, although technology has proven to be effective in providing patients and caregivers with confidence and may reduce their requests for help, direct monitoring and troubleshooting leads to increased health care–led phone calls and visits, predominantly around concerns about adherence and dialysis catheter malfunction. 52 Finally, the cost of remote patient monitoring set against potential health care savings remains unclear as most health economic analyses are based on modeling. 53,54…”