Assessment of Telehome Monitoring in Patients on Peritoneal Dialysis: A Multicentre Randomized Controlled Trial

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's467 enrolled

Overview

Compared to hemodialysis, patients on peritoneal dialysis live longer and healthier, have a higher quality of life and cost approximately $40,000 less to the healthcare system per patient per year. However, only 18% of dialysis patients in Canada currently use peritoneal dialysis because patients often feel isolated from the healthcare team and lack the confidence to manage treatments by themselves. This study will assess a telehome monitoring system (eQ Connect™), allowing for up-to-date data transmission and digital interaction between the patients at home and their healthcare team. From the patients' perspective, this technology is an easier way to communicate with their healthcare providers, track their treatment and supplies, and receive training and support. From the providers' perspective, eQ Connect™ delivers up-to-date patient data and provides an efficient way to keep track of the patients' progress. This intervention has the potential to improve the patients' clinical outcomes, quality of life, reduce the costs of dialysis to the healthcare system and ultimately empower patients to start and stay on peritoneal dialysis.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

467

Conditions

End-Stage Renal Disease

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Able to provide informed consent 2. Patient or primary care giver able to read and speak English 3. Over 18 years of age 4. Patient on PD (APD/CAPD) for at least 3 months 5. Patient or primary care giver cognitively and physically capable and willing to interact with a tablet computer and perform self-measurements (e.g. taking weight) Exclusion Criteria: 1. Scheduled kidney transplant within 1 year (identified, processed and medically worked out their donor) 2. Life expectancy \<1 year (estimated by physician) 3. In long-term care facility 4. Deemed unable to comply with the telehome monitoring support system (e.g. due to vision problems, literacy, lack of manual dexterity to accurately interact with the tablet, or decreased cognitive function such as memory loss) by physician 5. Participating in another interventional trial that could influence the intervention or outcome of this trial 6. Was in another interventional trial that could influence the intervention or outcome of this trial, ≤4 weeks prior to recruitment 7. Patients on hybrid dialysis (those on both peritoneal dialysis and hemodialysis)

Locations (11)

Royal Columbian Hospital - Fraser Health Authority

New Westminster, British Columbia, Canada

Seven Oaks General Hospital

Winnipeg, Manitoba, Canada

QEII Health Sciences Centre - Nova Scotia Health Authority

Halifax, Nova Scotia, Canada

St. Joseph's Healthcare Hamilton

Hamilton, Ontario, Canada

Kingston General Hospital

Kingston, Ontario, Canada

London Health Sciences Centre

London, Ontario, Canada

Trillium Health Partners - Mississauga Hospital

Mississauga, Ontario, Canada

Mackenzie Health

Richmond Hill, Ontario, Canada

Scarborough Health Network - General Hospital

Scarborough Village, Ontario, Canada

Humber River Hospital

Toronto, Ontario, Canada

...and 1 more locations

Outcomes

Primary Outcomes

Composite clinical outcome

The primary outcome is a composite of technique failure (switching to hemodialysis for ≥12 weeks), infections (peritonitis, exit-site, tunnel) and hospital encounters (ER visits, hospitalizations).

Time frame: 1 year (plus 12 weeks for complete follow-up of technique failure)

Secondary Outcomes

Health-related Quality of Life

This study will utilize the Kidney Disease Quality of Life-36 (KDQOL-36) Instrument and EQ-5D to assess HRQOL.

Time frame: 1 year

Time spent communicating

This measure captures the time a patient spends communicating with the healthcare team. This is measured through automated telephone logs and paper telephone logs that are documented by nurses. For patients in the intervention arm, investigators will also obtain the duration of video calls and amount of time spent on the message screen (number of minutes). We will also capture the number of messages that are sent on the telehome monitoring device.

Time frame: 1 year

Number of missed appointments

Investigators will examine the number of appointments that a patient has missed, which is documented through a scheduling software from the clinic.

Time frame: 1 year

Nurse Overtime hours

Investigators deliver care for the patients. The number of hours worked over-time are documented in a telephone log manually, which includes the patient's name, reason for call and call duration.

Time frame: 1 year

Number of clinic visits

The number of clinic visits will be collected through scheduling software from the PD clinic.

Time frame: 1 year

Hospitalization Days

Investigators will compare the length of hospitalizations (in days) between intervention and control group.

Time frame: 1 year

Nursing Costs

Investigators will compare costs by applying each centre's hourly nursing cost to the number of hours nurses spent communicating with the patient (derived from "time spent communicating" measure).

Time frame: 1 year

Healthcare Utilization Costs

Investigators will use the Case Costing Macro at ICES to compare the health utilization costs between two groups, including costs from emergency room visits and hospitalizations. (This is only applicable to the Ontario Centres).

Time frame: 1 year

Dialysis Supplies Costs

Investigators will compare the cost of supplies between the intervention and control group.

Time frame: 1 year