Thompson Stephanie, Schick-Makaroff Kara, Bello Aminu, Tonelli Marcello, Wiebe Natasha, Buzinski Robert, Courtney Mark, Szigety Susan, Shah Nikhil, Bohm Clara
University of Alberta, Edmonton, Canada.
University of Calgary, AB, Canada.
Can J Kidney Health Dis. 2021 Jul 27;8:20543581211032857. doi: 10.1177/20543581211032857. eCollection 2021.
People receiving in-center hemodialysis (HD) have prioritized the need for more individualized health information and better communication with nephrologists. The most common setting for patient-nephrologist interactions is during the HD treatment, which is a time pressured setting that lacks privacy.
To facilitate effective communication in the hemodialysis (HD) unit, we evaluated the usability of a web application (web app) from both the patient and physician perspective. The main aim of the web app was to support patients in prioritizing their dialysis concerns outside of the clinical HD encounter.
Mixed method, parallel arm, multi-site, pilot randomized controlled trial.
Two outpatient Canadian HD centers.
Adult patients receiving in-center HD and their attending nephrologists.
Patients were randomized to either a web application or an active control (paper form) for logging concerns to be addressed at weekly encounters with the nephrologist over 8 weeks. Topics included: HD treatment, symptoms, modality, and medications. The primary outcome was usability, defined as effectiveness (engagement with the tool, frequency of submitted concerns, whether the concern was satisfactorily addressed) and satisfaction with the tool using a priori thresholds and explored in interviews with patients and nephrologists.
77 patients (30 women, median age 61, interquartile range [53,67], median 2 years [1,4] on dialysis) and 19 nephrologists (4 women, median age 46 [36,65]) were enrolled. Patient use of a digital device at baseline was low (20%). Engagement with the tool was 70% (web app) and 100% (paper) with a lower proportion of patients in the web app group submitting at least one concern over 8 weeks compared to the paper form group: 56.7% vs 87.9%. Weekly concerns were satisfactorily addressed in both groups and ≥70% of patients would continue to use the tools. For patients, both tools promoted preparation and participation in the encounter; however, only the web app facilitated greater privacy in relaying concerns. For most nephrologists, the tools were disruptive to their workflow and were perceived as unnecessary given existing processes and familiarity with patients. For future versions of the app, patients suggested more features to facilitate self-management and nephrologists suggested integration with health databases and multidisciplinary teams.
Tertiary setting may limit generalizability.
Both tools promoted fundamental components of self-management; however, patients in the paper form group submitted concerns more often and this tool was easier to remember to use. Although modifications would likely enhance web app usability, successful future adoption is limited by physician acceptance. ClinicalTrials.gov NCT03605875.
接受中心血液透析（HD）的患者认为更个性化的健康信息以及与肾病专家更好的沟通至关重要。患者与肾病专家互动最常见的场景是在血液透析治疗期间，这是一个时间紧迫且缺乏隐私的环境。
为了促进血液透析（HD）科室的有效沟通，我们从患者和医生的角度评估了一个网络应用程序（网络应用）的可用性。该网络应用程序的主要目的是帮助患者在临床血液透析就诊之外优先处理他们对透析的担忧。
混合方法、平行组、多中心、试点随机对照试验。
加拿大两个门诊血液透析中心。
接受中心血液透析的成年患者及其主治肾病专家。
患者被随机分为网络应用程序组或积极对照组（纸质表格），用于记录在与肾病专家进行为期8周的每周会诊中要解决的问题。主题包括：血液透析治疗、症状、治疗方式和药物。主要结果是可用性，定义为有效性（与工具的互动、提交问题的频率、问题是否得到满意解决）以及使用先验阈值对工具的满意度，并通过对患者和肾病专家进行访谈来探究。
共招募了77名患者（30名女性，中位年龄61岁，四分位间距[53,67]，透析中位时间2年[1,4]）和19名肾病专家（4名女性，中位年龄46岁[36,65]）。基线时患者使用数字设备的比例较低（20%）。对工具的参与度在网络应用程序组为70%，在纸质组为100%；与纸质表格组相比，网络应用程序组在8周内提交至少一个问题的患者比例较低：56.7%对87.9%。两组的每周问题均得到了满意解决，且≥70%的患者会继续使用这些工具。对患者而言，两种工具都促进了会诊的准备和参与；然而，只有网络应用程序在传达问题时提供了更大的隐私性。对大多数肾病专家来说，这些工具扰乱了他们的工作流程，并且鉴于现有流程和对患者的熟悉程度，他们认为这些工具是不必要的。对于该应用程序的未来版本，患者建议增加更多功能以促进自我管理，肾病专家建议与健康数据库和多学科团队整合。
三级医疗机构环境可能会限制研究结果的普遍性。
两种工具都促进了自我管理的基本要素；然而，纸质表格组的患者更频繁地提交问题，并且该工具更容易记住使用。虽然进行修改可能会提高网络应用程序的可用性，但未来的成功采用受到医生接受度的限制。ClinicalTrials.gov NCT03605875。
