Telenephrology: Managing Chronic Kidney Disease during Covid-19 Pandemic

Introduction: The management of kidney diseases is challenging in areas where discrepancy exist between number of nephrologist and patient with kidney disease. COVID-19 pandemic added to these challenges. We initiated a tele-nephrology service in 2020 with primary aim of education, targeted screening and treatment of kidney diseases focusing where there was no nephrologist. Method(s): In this study locally available paramedics were mobilized for information dissemination and follow up of index patient population. The consultation was performed by internists and nephrologist. After initial registration in telemedicine service, social media apps were used for communication. The mode of communication used was audio, text, photography, and video call when needed. Follow-up consultation was done as required and in 3 months which involved review of reports and medical advised as needed including medication. We analyzed the data from the records of tele-nephrology service provided from April 2020 to April 2021 and who has completed at least 6 months of follow up. Result(s): A total of 266 participants who were known to have chronic kidney disease and hypertension were enrolled and followed up. The mean age of the participant was 54.21 + 17 years. Females constitute 53% (n=141). The most common mode of communication was WhatsApp (86.5%), followed by Viber (5.6%). Patients were advised to undergoes investigations in nearby health care facilities as needed. Most of the participants (88.0%, n=232) were managed without need for physical hospital visit. Physical visit to hospital was needed in 84 patients (17%) and 4.1% (n=11) needed hospital admission. During follow up, half of the participants (n=134) had performed tests as advised and 44.4% (n=118) followed the treatment advised, in initial consultation and needed further advice to do so. Five persons died during follow-up (1.9%). Few participants 1.1%(n=3) said that they don't want to use the telemedicine service again. Conclusion(s): Tele-nephrology services can bridge the gap in care in nephrology where access to nephrologists is limited. No conflict of interestCopyright © 2023

Evaluation of the experience with the use of telemedicine in a home dialysis program-a qualitative and quantitative study.

INTRODUCTION: Assisted home hemodialysis is a therapeutic modality for patients diagnosed with end-stage renal disease who require dialysis replacement therapy and have concomitant health limitations that prevent them from attending a satellite dialysis unit or performing their own treatment. OBJECTIVE: The main objective of this study was to evaluate whether telemedicine provided through telemonitoring can improve the ongoing relationship between the doctor, the nurse and the patient. METHOD: This prospective longitudinal, qualitative and quantitative study analyzes the impact of telemedicine through an evaluation of the experiences of patients and nurses. During the study, we performed remote weekly monitoring for 6 months. RESULTS: A total of 17 patients and 12 nurses were included. We observed that the patients and nurses had positive experiences with telemonitoring and highlighted feelings of being cared for and improved confidence, although they indicated that telemonitoring does not replace face-to-face visits. CONCLUSION: Telemonitoring is a useful tool to increase satisfaction with and confidence in home hemodialysis.

POS-319 TELENEPHROLOGY AS A PUBLIC POLICY FOR THE CARE OF PATIENTS WITH CKD AT THE PRIMARY HEALTH LEVEL. CHILEAN EXPERIENCE

Introduction: There are successful reports of the use of telemedicine in nephrology (TN), which would facilitate the access of patients with chronic kidney diseases (CKD) from the primary health centers (PHCs) to the nephrologist. Since 2019, TN has been implemented in Chile as a public health policy with national coverage. The process and outcome indicators associated with the Chilean National TN Program among PHCs and reference nephrologists are described. Methods: Descriptive study of asynchronous telemedicine care performed from urban and rural PHCs (574) (municipal health centers) to 17 nephrologists from Hospital Digital, between January 01, 2019 and June 30, 2021. The percentage of the rural population in Chile is 12.1%. Teleconsultations are sent by the PHCs doctor through a digital platform that contains clinical information, laboratory tests and treatments. The nephrologist in a deferred time, responds in the same way and decides between the options: 1) Counter-refer the patient to PHCs requesting more information or with treatment recommendations;2) Refer to a hospital for more complex studies or treatments. The following were analyzed: 1. Distribution by age, sex and comorbidities;2. Response times;3. Prevalence of CKD by stages;4. Destination post evaluation TN;5. Level of relevance of PHCs consultations. Results: In total, 12.705 asynchronous telemedicine visits were performed (2019: 50.8 %;2020: 31.9 %;2021:17.3%. During the Covid-19 pandemic, attention for TN was maintained although restricted by the health crisis in the public health network. The mean age was 65.9 (SD: 13.2) years;80% were older than 60 years;57%% women. CKD stages: S1 (8.5%%);S2 (16.2%);S3 (53.6%);S4 (17.9%) and S5 (3.7%). Comorbidities: diabetes 56%, hypertension 90.7%, dyslipidemia 65%, overweight 29.2% and obesity 38.7%. The average response time was 91 hrs. (range 1- 173). In total, 7.954 patients (62.6%) were referred to PHCs with recommendations, without requiring transfers to another center. In turn, 4.751 patients (37.4%) required face-to-face nephrological evaluation (58.1% high priority for CKD in stages 4-5). The relevance of the consultations according to the nephrologist's evaluation was considered high 23.1% and median 49.3%. Conclusions: The implementation of TN as a public policy has made it possible to facilitate expeditious access, evaluation and timely treatment of patients with CKD from urban and rural PHCs and prioritize face-to-face care by a nephrologist for those with greater risk or severity. Most of the patients evaluated (62.8%) were referred to PHCs, optimizing the limited space and high demand of face-to-face care per specialist. During the Covid-19 pandemic period, the use of TN was restricted but allowed continuity of control of patients with CKD and decongest PHCs and emergency care centers. Future studies should evaluate the impact of TN in the follow-up of patients screened with CKD, especially in stages 3-5, the decrease in travel-related CO2 emissions due to reduced displacement, the level of patient´s satisfaction/PHCs teams, and the evaluation effective cost of this care modality. No conflict of interest

A Quantitative and Qualitative Study on Patient and Physician Perceptions of Nephrology Telephone Consultation During COVID-19.

BACKGROUND: COVID-19 required rapid adoption of virtual modalities to provide care for patients with a chronic disease. Care was initially provided by telephone, which has not been evaluated for its effectiveness by patients and providers. This study reports patients' and nephrologists' perceptions and preferences surrounding telephone consultation in a chronic kidney disease (CKD) clinic. OBJECTIVE: To evaluate patient and physician perspectives on the key advantages and disadvantages of telephone consultations in a nephrology out-patient clinic setting. DESIGN: Cross-sectional observational survey study. SETTING: General nephrology clinic and a multidisciplinary kidney care clinic in London, Ontario, Canada. PARTICIPANTS: Patients with CKD who were fluent in English and participated in at least one telephone consultation with a nephrologist during the COVID-19 pandemic. METHODS AND MEASUREMENTS: Nephrologists' and participants' input facilitated the development of both patient and nephrologist surveys. Participants provided self-reported measures in 5 domains of satisfaction: user experience, technical quality, perceived effectiveness on well-being, perceived usefulness, and effect on interaction. Nephrologists provided self-reported measures within 6 categories: general experience, time management, medication changes, quality of care, job satisfaction, and challenges/strengths. Descriptive statistics were used to present data. Content analysis was performed on 2 open-ended responses. RESULTS: Of the 372 participants recruited, 235 participated in the survey (63% response). In all, 79% of the participants were ≥65 years old and 91% were white. Telephone consultation was a comfortable experience for 68%, and 73% felt it to be a safer alternative during the pandemic. Although 65% perceived no changes to health care access, most reported spending less time and fewer resources on transit and parking. Disadvantages to telephone consultation included a lack of physical examination and reduced patient-physician rapport. Eleven of 14 nephrologists were surveyed, with most reporting confidence in the use of telephone consultation. Physician barriers to telephone consultation included challenges with communications and lack of technology to support telephone clinics. LIMITATIONS: Our survey included a majority of older, white participants, which may not be generalizable to other participants particularly those of other ages and ethnicity. CONCLUSION: Although both patients and nephrologists adapted to telephone consultations, there remain opportunities to further explore populations and situations that would be better facilitated with an in-person visit. Future research in virtual care will require measurement of health care outcomes and economics. TRIAL REGISTRATION: Not applicable as this was a survey.