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腹膜透析患者远程监测的安排

Scheduling of Remote Monitoring for Peritoneal Dialysis Patients.

作者信息

Virzì Grazia Maria, Morisi Niccolò, Milan Manani Sabrina, Tantillo Ilaria, Gonzàlez Barajas José David, Villavicencio Bladimir Diaz, Castiglione Claudia, Alfano Gaetano, Donati Gabriele, Zanella Monica

机构信息

Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy.

IRRIV-International Renal Research Institute Vicenza Foundation, 36100 Vicenza, Italy.

出版信息

J Clin Med. 2024 Jan 11;13(2):406. doi: 10.3390/jcm13020406.

Abstract

Peritoneal dialysis (PD) is performed as a home-based treatment and in this context, telemedicine has been proven helpful for improving clinicians' surveillance and maintaining PD patients in their home setting. The new e-health devices make remote patient monitoring (RPM) for automated peritoneal dialysis (APD) treatment possible, evaluating the data at the end of every treatment and adapting the prescription at distance if necessary. This paper aims to share a method for improving clinical surveillance and enabling PD patients to receive their treatment at home. In the present case series, we delineate the clinical protocol of the Vicenza PD Center regarding patient characteristics, timing, and the purpose of the APD-RPM. We present the Vicenza PD Center's experience, illustrating its application through three case reports as exemplars. Telemedicine helps to carefully allocate healthcare resources while removing the barriers to accessing care. However, there is a risk of data overload, as some data might not be analyzed because of an increased workload for healthcare professionals. A proactive physician's attitude towards the e-health system has to be supported by clinical instructions and legislative rules. International and national guidelines may suggest which patients should be candidates for RPM, which parameters should be monitored, and with what timing. According to our experience, we suggest that the care team should define a workflow that helps in formulating a correct approach to RPM, adequately utilizing resources. The workflow has to consider the different needs of patients, in order to assure frequent remote control for incident or unstable patients, while prevalent and stable patients can perform their home treatment more independently, helped by periodic and deferred clinical supervision.

摘要

腹膜透析(PD)是一种居家治疗方式,在这种情况下,远程医疗已被证明有助于改善临床医生的监测,并使PD患者能够在家中接受治疗。新型电子健康设备使自动腹膜透析(APD)治疗的远程患者监测(RPM)成为可能,在每次治疗结束时评估数据,并在必要时远程调整处方。本文旨在分享一种改善临床监测并使PD患者能够在家中接受治疗的方法。在本病例系列中,我们描述了维琴察PD中心关于患者特征、时间安排和APD-RPM目的的临床方案。我们介绍了维琴察PD中心的经验,并通过三个病例报告作为示例来说明其应用。远程医疗有助于合理分配医疗资源,同时消除获得护理的障碍。然而,存在数据过载的风险,因为由于医护人员工作量增加,一些数据可能无法得到分析。临床指导和立法规则必须支持医生对电子健康系统的积极态度。国际和国家指南可能会建议哪些患者应成为RPM的候选对象、应监测哪些参数以及监测的时间安排。根据我们的经验,我们建议护理团队应定义一个工作流程,以帮助制定正确的RPM方法,充分利用资源。该工作流程必须考虑患者的不同需求,以便确保对新发或不稳定患者进行频繁的远程控制,而病情普遍且稳定的患者在定期和延期的临床监督帮助下可以更独立地进行居家治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b5da/10816117/5dca23d1d9fd/jcm-13-00406-g001.jpg

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