Abstract
Background and Aims
Home dialysis (both extracorporeal and peritoneal) can improve the management and the quality of life of patients affected by end stage renal disease. Remote patient monitoring (RPM) can improve the care of Patients in home dialysis: RPM may detect early problems, ensure compliance and give both clinicians and patients a sense of reassurance regarding the clinical management. These advantages may translate into improved outcomes and increased uptake on home dialysis therapies.
For these reasons, the Doctor Plus® NEPHRO program has been created. Clinical and social advantages derived from remote patient monitoring by the Doctor Plus® NEPHRO program versus the standard of care were evaluated.
Method
Patients included in the remote monitoring program, by the Nephrology Unit of ASL 3 in Rome (Italy), from July 2017 and April 2019, were analyzed. Each patient was observed for at least 4 months, up to 22 months.
Patients received a Doctor Plus® NEPHRO KIT composed by clinical devices to measure systolic and diastolic pressure, heart rate, body weight and oximetry. Clinical data were automatically sent from electronic devices to the HUB included into the provided KIT and from the HUB to the Vree Platform operating at the Nephrology Unit. All devices, included HUB and Vree Platform, were classified as medical device class IIa.
The SF-12 questionnaire was also administered by remote nurses and the level of satisfaction with the program Doctor Plus® NEPHRO was evaluated.
Results
We observed 16 patients (56,3% males, mean age 62 years), 14 in Peritoneal Dialysis and 2 in Home Hemodialysis. A total number of 35.720 clinical measures were collected during the observational period.
During this length time, systolic pressure was reduced in 69% of patients and diastolic pressure was reduced in 62,5% of patients. Systolic pressure decreased from 137,8 to 130,2 mmHg (p<0,0002) and diastolic pressure decreased from 80,5 to 76 mmHg (p>0,0002). Mean heart rate decreased in 50% of patients from 69,4 bpm to 68,8 bpm (p<0,0046).
During the same period, clinical monitoring generated 58 early clinical interventions: 11 non planned visits at Nephrological Centre and 47 calls from nephrologist to patients (0,5 visits per month and 2,2 calls per month). In 35 cases pharmacological therapy has been modified (in 80% of cases treatment modified was the hypertension therapy).
Due to the increase of clinical monitoring, Patients accesses to ER are decreased of 29%.
SF-12 questionnaire showed an improvement in the perceived health status in all patients. Reduction of 15% in workdays lost were registered in both patients and caregivers.
Conclusion
Doctor Plus® NEPHRO resulted as a useful tool for the Nephrology Center in order to monitor patients who performed home dialysis. Data collected by the remote monitoring program have shown an improvement in clinical outcomes and the possibility to prevent some clinical complications thus reducing clinical emergencies and the hospitalization rate. Moreover, the possibility for patients and caregivers to complain with morbidity remaining in a home setting, results in the improvement in quality of life.
Finally, the possibility to avoid hospitalizations, emergency accesses and transfers to hemodialysis is important for cost saving with a more appropriate use of healthcare resources.
A flexible protocol for a systematic review of remote patient monitoring
