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Proactive Patient Management

Background

Background

APD patients are required to record details of their therapy and clinical data on a daily basis. These details are then reviewed at each clinic visit as part of the overall assessment.

1

Two-way connectivity provides an opportunity for early intervention of dialysis issues in what has been predominately reactive care.

2

Remote Patient Management (RPM) enables patients to be effectively prioritized.

3

New APD cyclers with two-way RPM technology allows nurses to view dialysis details remotely in a timely manner, proactively manage clinical issues and make program changes as needed.

Objectives

Objectives

Evaluate the impact of
RPM on nurses’ behavior
and practice in caring for
APD patients at home.

Assess if changing the frequency that
the patients' dialysis details are remotely
viewed by nurses would impact their
ability to manage patients proactively.

Identify if RPM helps
improve patient
management and
clinic efficiency.

Study Design

Method

Four PD nurses from 4 UK hospitals were observed prior and post use of APD with RPM

A tool was designed to log the time PD nurses spend on different types of task, specifically whether the task is:

  • PROACTIVE - Anticipatory, preventative and change oriented (e.g. clinician discussions, phone calls/visits to patients and reviewing daily dialysis records)
  • REACTIVE - Responsive (e.g. urgent patient consultations and assessments)
  • ROUTINE - Regular planned activities (e.g. scheduled line changes and review consultations)

PD nurses were observed and their behavior logged throughout their working day on two occasions:

  • Once between July 2015 and July 2016 (before the introduction of APD with Remote Patient Management)
  • Once between September 2016 and March 2017 (6–13 months after APD with Remote Patient Management was established)

Note: Claria with Sharesource was used in this study which is similar in function, design and indication to Amia with Sharesource

Results

What have we seen so far?

Proactive patient care activities increased from 2% of nurses' time without RPM to 34% with RPM.

PercentageTimeSpent
 FrequencyNurseReview

Conclusions patient-management

conclusions

Conclusions

 

Establishing RPM in four UK renal units has allowed PD nurses to increase their time spent on proactive tasks by 32 percentage points.

Routine and reactive tasks were reduced, potentially contributing to shift of PD nurses’ behaviors.

Information received daily should allow for earlier intervention and prescription changes to address potential clinical issues.

Clinicians switching from APD to APD with Sharesource Connectivity Platform spent a greater proportion of time on proactive patient care, which may improve patient management and nurse efficiency.

McCarthy K. et al, Remote monitoring of peritoneal dialysis: evaluating the impact of the Claria Sharesource system Journal of Kidney Care 2019; Vol 4 No 1.

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