Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD
Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD
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DOI：
10.2215/cjn.10681015
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发表时间：
2016-06-01
影响因子：
9.8
通讯作者：
Logan, Alexander G.
中科院分区：
文献类型：
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作者：
Ong, Stephanie W.;Jassal, Sarbjit V.;Logan, Alexander G.
背景和目的患者自我管理已被证明可以改善健康结果。我们开发了一个基于智能手机的系统来促进慢性肾病患者的自我护理，并将其整合到常规慢性肾病护理中。我们确定了它的可接受性，并检查了几个临床参数的变化。设计、设置、参与者和测量我们招募了在门诊肾脏诊所就诊的4期或5期CKD患者，这些患者对这项为期6个月的原理验证研究的一般信息简报有反应。这款智能手机应用程序针对四个行为要素：监测血压、药物管理、症状评估和跟踪实验室结果。预先构建的可定制算法提供实时个性化的患者反馈，并在超过预定义的治疗阈值或发生重大变化时向提供者发出警报。在前2个月内死亡或开始RRT的患者被替换。只有在招募后随访6个月的参与者被纳入评估临床测量的变化。结果共纳入47例患者（男性26例，平均年龄59岁，33%年龄65岁）；60%的人从未使用过智能手机。用户依从性高（> = 80%的推荐评估）并持续。在基线和出院期间，家庭血压读数的平均降低具有统计学意义（收缩压，-3.4 mmHg， 95%可信区间，-5.0至-1.8，舒张压，-2.1 mmHg， 95%可信区间，-2.9至-1.2）；27%的临床血压读数正常的人新发现了隐蔽性高血压。发现了127个用药差异；59%是需要干预以防止伤害的药物错误。在离职面谈中，患者表示感觉更自信，并能控制自己的病情；临床医生认为患者更了解情况，更投入。结论将基于智能手机的自我管理系统整合到晚期CKD患者的日常护理中被证明是可行和可接受的，并且在临床上似乎是有用的。结果为随机对照试验提供了强有力的依据。
Background and objectives Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters.Design, setting, participants, & measurements We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures.Results In total, 47 patients (26 men; mean age =59 years old; 33% were >= 65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (>80% performed >= 80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors 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.Conclusions Integrating a smartphone based self management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial.