Milan Manani Sabrina, Crepaldi Carlo, Giuliani Anna, Virzì Grazia Maria, Proglio Marta, Ronco Claudio
Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy,
International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy,
Contrib Nephrol. 2019;197:124-132. doi: 10.1159/000496319. Epub 2019 Apr 8.
Chronic diseases are a global concern and a leading cause of death and disability. These conditions require intensive and ongoing medical assistance to maximize outcomes and avoid the risk of frequent flare-ups and hospitalizations, which increase the cost of healthcare. Remote patient management (RPM) is a strategy that allows for accurate home monitoring of chronic patients, enabling the team to improve care through prevention and early identification of problems, with consequent timely interventions. Peritoneal dialysis (PD) is a home-based therapy representing an ideal model for testing the ability of RPM to improve clinical outcomes by allowing the 2-way link between health providers and patients. The literature and our own results confirm that RPM applied to automated peritoneal dialysis (APD) allows an efficient use of healthcare resources, helping to improve tailoring of APD prescription and to intervene early with troubleshooting, reducing the frequency of in-person visits for emergency problems. RPM-APD is today made possible by a cloud-based software providing bidirectional communication between patient's home and the hospital care team (Cycler HOMECHOICE CLARIA with SHARESOURCE platform). This approach can be useful in promptly identifying patients with higher risk of complications: a knowledge-based management permits the reduction of urgent events, and the prevention of clinical complications improving patient outcomes. In our experience, matured over 2 years in a cohort of prevalent patients, we observed a significant reduction of patient drop-out and technique failure, the number of scheduled and unscheduled hospital visits, the number of episodes of overhydration, rate of hospitalization, episodes of non-compliance to prescription, patient and hospital team time spent in travelling and management of therapy, healthcare costs and patient's expenditure, miles travelled by patients from home to hospital and vice versa. The cost/benefit analysis is strongly in favor of the RPM-APD modality versus the traditional periodic hospital visit regime.
慢性病是一个全球性问题，也是导致死亡和残疾的主要原因。这些疾病需要密集且持续的医疗援助，以实现最佳治疗效果，并避免频繁发作和住院的风险，因为这会增加医疗成本。远程患者管理（RPM）是一种策略，可对慢性病患者进行准确的居家监测，使医疗团队能够通过预防和早期问题识别来改善护理，并及时进行干预。腹膜透析（PD）是一种居家治疗方法，是测试RPM改善临床结局能力的理想模型，因为它允许医疗服务提供者与患者之间进行双向联系。文献和我们自己的研究结果证实，将RPM应用于自动化腹膜透析（APD）可有效利用医疗资源，有助于改进APD处方的调整，并在出现故障时尽早进行干预，减少因紧急问题进行的面对面就诊次数。如今，基于云的软件实现了RPM-APD，该软件可在患者家中与医院护理团队之间进行双向通信（配备SHARESOURCE平台的Cycler HOMECHOICE CLARIA）。这种方法有助于迅速识别并发症风险较高的患者：基于知识的管理可减少紧急事件，并预防临床并发症，从而改善患者结局。根据我们在一组现患患者中长达两年的经验，我们观察到患者退出率和技术失败率、计划内和计划外住院就诊次数、水过多发作次数、住院率、处方不依从发作次数、患者和医院团队在出行和治疗管理上花费的时间、医疗成本和患者支出、患者往返医院的里程数均显著减少。成本效益分析强烈支持RPM-APD模式，而非传统的定期医院就诊模式。
