ABSTRACT
Background: Minimising patient contact is more important amidst the COVID-19 pandemic;yet altering follow-up data collection methods may introduce unintentional bias. We describe our findings from the European Quality (EQUAL) study in which UK patients switched from 'traditional' clinic follow-up (TFU) to 'efficient' postal follow-up (EFU). Methods: EQUAL is a prospective study on treatment in people aged ≥65 with advanced chronic kidney disease (eGFR ≤20mL/min/1.73m2). UK patients were recruited to EQUAL from 2013-2017. During TFU, patients were invited to complete a questionnaire (SF-36, Dialysis Symptom Index and Renal Treatment Satisfaction Questionnaire) at research clinics every 3-6 months. In 2018, all alive patients were invited to switch to EFU, which used an abbreviated questionnaire administered centrally by post. Questionnaire response and error rates for six-monthly TFU and the first EFU are presented for UK patients who consented to EFU. Results: In total, 506 UK patients were recruited. In 2018, 236 of these patients were alive and almost half (n=111) consented to the change in follow-up. Of those consenting to EFU, response rates fell from 88.2% (98/111) to 59.0% (65/110) for patients who completed 1.5 years of TFU. Of those who were recruited earlier and had completed 3.5 years of TFU, response rates fell again to 20% (3/15). The response rate for the first EFU questionnaire was 59.6% (59/99) of those alive. Errors almost trebled throughout TFU, before falling to baseline at the first EFU. Conclusions: In this prospective study of older people with advanced CKD, response rates fell and error rates rose during TFU. On introducing a shorter postal questionnaire, response and error rates improved to levels resembling early TFU. This suggests that even in older people with advanced CKD, returning questionnaires by post is acceptable and may provide more complete data than costly TFU. This is acutely relevant in this period of limited contact in the COVID-19 pandemic.