Harnessing mobile health technology to personalize the care of chronic kidney disease patients
Technology: e-Solutions and Telemedicine
Alexander G. Logan
Nephrology, Mount Sinai Hospital and University Health Network, Univ of Toronto
Self-management has been advocated as a way for patients to cope with the challenges of living with complex chronic illnesses. However, to be effective and sustainable self-care activities need to be integrated into the overall goals of care. Our team developed a smartphone-based, self-management system that incorporates key elements of the chronic care model. It automatically tracks patient-directed activities between clinic visits, provides personalized feedback responses in real time and populates a readily accessible, secure web-based clinical dashboard with patient-derived data to aid clinical decision-making and generate alerts for patients and their care team when pre-defined thresholds are crossed or critical changes occur. In our pilot study the system was well-accepted and improved knowledge, health behaviours and clinical outcomes of chronic kidney disease patients. Our system, built from commercial products to minimize cost, is easily adaptable to any set of chronic conditions.
Project Team: AG Logan, SW Ong, SVJassal, EC Porter, JA Cafazzo, E Seto, KE Thorpe, JA Miller
Objectives: We determined the acceptability of a smartphone-based system to boost self-care by patients with chronic kidney disease (CKD) and assessed changes in several clinical parameters.
Methods: We recruited stage 4 and 5 CKD patients attending out-patient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: blood pressure (BP), medication management, symptom assessment and tracking laboratory results. Pre-built, customizable algorithms provided real-time personalized patient feedback and alerts to providers when pre-defined treatment thresholds were crossed or critical changes occurred.
Results: 47 patients (26 male), mean age 59 years (33%, ≥65 years), were enrolled. 60% had never used a smartphone. User adherence was high (>80% performed at least 80% of recommended assessments) and sustained. The mean reduction in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval (CI) -5.0, -1.8) and diastolic BP, -2.1 mmHg; 95% CI -2.9, -1.2). 27% with normal clinic BP readings had newly identified masked hypertension. 127 medication discrepancies were identified; 59% were a medication error that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged.
Conclusion: Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved to be feasible, acceptable and clinically useful. Our system is inexpensive, adaptable and scalable.