Epharmix Research Center, Washington University School of Medicine, St. Louis, USA.
Saint Louis University School of Medicine, St. Louis, USA.
Sci Rep. 2017 Jun 23;7(1):4177. doi: 10.1038/s41598-017-03184-z.
Comorbidities and socioeconomic barriers often limit patient adherence and self-management with hemodialysis. Missed sessions, often associated with communication barriers, can result in emergency dialysis and avoidable hospitalizations. This proof of concept study explored using a novel digital-messaging platform, EpxDialysis, to improve patient-to-dialysis center communication via widely available text messaging and telephone technology. A randomized controlled trial was conducted through Washington University-affiliated hemodialysis centers involving ESRD patients with poor attendance, defined as missing 2-6 sessions over the preceding 12 weeks. A cross-over study design evaluated appointment adherence between intervention and control groups. Comparing nonadherence rates eight weeks prior to enrollment, median appointment adherence after using the system increased by 75%, and median number of unintended hospitalization days fell by 31%. A conservative cost-benefit analysis of EpxDialysis demonstrates a 1:36 savings ratio from appointment adherence. EpxDialysis is a low-risk, cost-effective, intervention for increasing hemodialysis adherence in high-risk patients, especially at centers caring for vulnerable and low-income patients.
合并症和社会经济障碍常常限制了患者接受和自我管理血液透析的能力。由于沟通障碍导致的错过治疗，可能会导致紧急透析和可避免的住院治疗。这项概念验证研究探索了使用一种新型的数字信息平台 EpxDialysis 通过广泛使用的短信和电话技术改善患者与透析中心之间的沟通。这项通过华盛顿大学附属的血液透析中心进行的随机对照试验涉及 attendance，定义为在过去 12 周内错过 2-6 次治疗。交叉研究设计评估了干预组和对照组之间的预约依从性。在使用该系统后，预约依从性中位数增加了 75%，非依从性率从 8 周前的 75%下降到 31%。对 EpxDialysis 的保守成本效益分析表明，从预约依从性方面来看，该系统的投入与产出比为 1:36。EpxDialysis 是一种低风险、具有成本效益的干预措施，可提高高危患者（尤其是为弱势群体和低收入患者提供服务的中心）的血液透析依从性。
