The Use of a Tablet Computer Platform to Optimize the Care of Patients Receiving Peritoneal Dialysis: A Pilot Study

Abstract

Background: Peritoneal dialysis (PD) affords patients increased independence and improved quality of life. However, the lack of more frequent monitoring may compromise outcomes and decrease wider uptake of this modality. This study uses a novel tablet computer-based interface to allow real-time monitoring and two-way communication to better link PD patients with a dialysis center and care providers. Methods: A tablet computer with an application that allows enhanced monitoring of all aspects of PD was given to patients to assess their usage in a pilot trial. The interface allows patients to review sterility techniques, enter vital signs and exchange data, upload media such as photos and video clips, synchronize data to be viewed by medical staff, and allow real-time adjustments to the PD prescription. Satisfaction with the interface and comments for enhancement were analyzed using a simple self-administered questionnaire. Results: Six continuous ambulatory PD patients were enrolled in this pilot study. A total number of 1,172 exchanges were recorded over a period of 251 days. Compliance with the applications ranged from 51 to 92%. No major adverse events were recorded. The overall impression of the interface was 5.2 out of 10. The major criticism was that the application needs to be adjusted depending upon the experience level of the patient and that data entry needs to be simplified and automated. Conclusion: A tablet computer platform is a feasible concept for continuous ambulatory PD. The major components include flexibility, advanced infrastructure, two-way communication, and real-time interaction. This may encourage more patients to take up PD as their preferred modality of therapy for end-stage renal disease. Modifications to enhance use will be incorporated in subsequent versions.

Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient’s Independence

“…These results are in accordance with Nayak et al [13]: they speculated that RM of patients on APD offers benefits of real-time monitoring of the therapy, assuring patient safety through the surveillance of critical portions of the treatments, and, on the other hand, enabling early detection of noncompliance [10]. A system with 2-way communications and with an interactive interface allows a fast “troubleshooting” for problems: the physicians can change the prescription online, reducing the frequency of in-person visits to a PD center [13, 14]. …”

Perspectives from the Kidney Health Initiative on Advancing Technologies to Facilitate Remote Monitoring of Patient Self-Care in RRT

“…Many of these benefits, although intuitive, are currently hypothetic and few clinical studies (Table 2 lists clinical studies in this area) have demonstrated specific benefits of telehealth services for patients with ESRD. The current literature in this are single center experiences utilizing telemedicine for the care of patients receiving HD (14-23) or PD (24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Thus, studies that address the utility of telehealth and include endpoints of interest to patients, providers, and payers (i.e., improvements in mortality, lowering of readmission rates, improved quality of life, and cost savings) are needed.…”

“…Telehealth platforms that utilize video conferencing may allow the care team to monitor patients while they perform self-care, provide feedback on patient techniques, and institute continuous education programs that help ensure survivability of the home dialysis technique through avoidance of complications such as peritonitis, catheter exit site infections, or needle-stick injuries. For example, a telehealth system for patients receiving PD has been reported that embeds best-practice care steps into a tablet computer application as well as providing the ability for the care team to monitor the patient performing PD exchanges (27). Patients using this system reported high degrees of satisfaction with these features.…”

“…Through the provision of a suite of telehealth services, patient satisfaction may increase with home therapies. Although small studies support the idea that patient satisfaction with telemedicine care for patients with ESRD will be high, further studies are needed in this domain (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). There are potential downsides to telemedicine in terms of perceived intrusion into privacy and depersonalization that will also need to be investigated.…”

Longitudinal Experience with Remote Monitoring for Automated Peritoneal Dialysis Patients

“…It allows for accurate home monitoring of patients enabling the team to improve care through prevention and early identification of problems, with consequent timely interventions. In this view, TM and RM may have important reflections on prognosis, outcomes, and quality of life [4]. RM has proved to be useful in chronic diseases where frequent controls are particularly useful such as heart failure, diabetes, and hypertension [5,6].…”