Cafazzo Joseph A, Leonard Kevin, Easty Anthony C, Rossos Peter G, Chan Christopher T
Centre for Global eHealth Innovation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Hemodial Int. 2010 Oct;14(4):471-7. doi: 10.1111/j.1542-4758.2010.00473.x.
Adoption of nocturnal home hemodialysis (NHHD) has been slow, due in part to patient-perceived barriers, such as anxiety and lack of self-efficacy. This study investigates patient perception of remote monitoring in addressing these barriers. Perceptions of remote patient monitoring (RPM) were studied through a quantitative survey and qualitative interviews. The NHHD and conventional hemodialysis (CHD) were included in the survey (209 in total). Twenty semistructured interviews were conducted as well as a focus group that included NHHD patients and family caregivers. The CHD patients had greater interest in adopting NHHD with RPM than without (1.90±1.37 vs. 1.71±1.28, P<0.002), with the negative intensity ratio declining from 10.50 to 5.56. Interest in RPM was correlated with interest in NHHD (r=0.768, P<0.001). Other significant factors correlated with interest in NHHD include the belief that remote monitoring will ease the performing of NHHD (r=0.452, P=0.001) and the belief that RPM should be mandatory (r=0.541, P=0.000). Qualitative findings supported three themes: (1) There is an expectation for the use of RPM, (2) RPM should be used at a minimum transitionally, and (3) RPM acts as a surrogate support of family-caregivers. The RPM may lower perceived barriers to the adoption of NHHD, in part through its surrogate support of family caregivers. However, RPM alone is likely insufficient to alter patients' attitudes to undergo NHHD. RPM is a common expectation of CHD patients considering the therapy, at a minimum during the transitional phase.
夜间家庭血液透析（NHHD）的采用进展缓慢，部分原因是患者感知到的障碍，如焦虑和缺乏自我效能感。本研究调查了患者对远程监测以解决这些障碍的看法。通过定量调查和定性访谈研究了对远程患者监测（RPM）的看法。调查纳入了NHHD和传统血液透析（CHD）患者（共209例）。进行了20次半结构化访谈以及一个包括NHHD患者和家庭照顾者的焦点小组。与不采用RPM相比，CHD患者对采用带RPM的NHHD更感兴趣（1.90±1.37对1.71±1.28，P<0.002），负强度比从10.50降至5.56。对RPM的兴趣与对NHHD的兴趣相关（r=0.768，P<0.001）。与对NHHD的兴趣相关的其他重要因素包括相信远程监测将简化NHHD的实施（r=0.452，P=0.001）以及认为RPM应是强制性的（r=0.541，P=0.000）。定性研究结果支持三个主题：（1）对使用RPM有期望，（2）RPM至少应在过渡阶段使用，（3）RPM可作为家庭照顾者的替代支持。RPM可能会降低采用NHHD时感知到的障碍，部分原因是它对家庭照顾者的替代支持。然而，仅RPM可能不足以改变患者接受NHHD的态度。对于考虑接受该治疗的CHD患者来说，至少在过渡阶段，RPM是一种普遍的期望。
