chronic disease management: The PD-Buddy platform Dr. Manuel - - PowerPoint PPT Presentation

PD BUDDy: Mobile technology can provide support in home-based peritoneal dialysis for patients with chronic kidney disease

• Dr. Manuel Gonzalez Garcia

Australian eHealth Research Centre (AEHRC) 2

• 1. Presentation of the AEHRC’s mobile-health platform

2.Provide an example of m-Health supporting chronic disease management: The PD-Buddy platform

Delivery of healthcare interventions using mobile computing platforms

HIC 2017| Manuel Gonzalez Garcia| AEHRC

The AEHRC m-Health platform

Smartphone application Web portal The whole system

Our m-Health platform is different…

Patient comments… Clinician comments…

“The MoTER program gave me a better understanding of my disease”

“Recording and seeing weight and blood pressure every day helped me to be more motivated to exercise and be more active”

“Someone to talk to if any issues” “I wish the program went for longer” “The MoTER program is the preferred option for patients who are shift workers, live in rural areas, have transport issues, or for patients who are the main carer for a loved

• ne”

“The MoTER program has huge potential to provide a home based care”

“Clients appreciate the individualised attention”

M-Health….. The future

The disease Chronic kidney disease (CKD)

• 1.7 million Australians aged 18 years and over
• In 2012, the total costs attributable solely to CKD

were an estimated $4.1 billion, $2.5 billion in direct healthcare costs

• Dialysis is the most common single reason for

hospital care.

Australian Institute of Health and Welfare, 2015

loss of kidney function that occurs over a prolonged course of time

• A home-undertaken type of dialysis that uses the

peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and removed toxins.

• Continuous Ambulatory Peritoneal Dialysis (CAPD)

involves fluid transfer to and from the peritoneal cavity each day (X4).

• Automated Peritoneal Dialysis (APD) involves a machine

which cycles fluids through the abdomen overnight

• Self managed home treatment. Monitoring home dialysis

patients may be challenging and requires effective tools of communication between patients and clinicians

PD: Peritoneal dialysis

PD: Peritoneal dialysis

The use of PD to manage CKD requiring dialysis is growing significantly, both as the first dialysis modality and within 6 months

• f starting dialysis (ANZDATA, 2016).

The graph shows the growth of PD patients at Logan hospital since opening of the service in 2011 to 2014. At Logan Hospital from 2011, when the PD Unit first opened with 30 patients, numbers increased to 65 by December 2015.

Sub-optimal management of home dialysis patients

EXERCISE BOOK

X 4

Books are often lost or not brought into clinics

Time wastage

• Inefficient use of time

spent attempting to gain accurate information

Growing population

Appointment non- adherence

• Information overload
• Incomplete documentation

Not aligned with current available technology

• Time consuming for patients

Confusion

Proposed Solution

“The customisation of the CR platform to deliver care components to PD individuals, support them in their home-setting and enhance PD service delivery”

The majority of patients never forget to bring their phone to PD clinic visits

• Increase patient satisfaction and engagement
• Reduce time spent at clinic appointments
• Improve communication channels and documentation process

Innovative technology

Proposed Benefits

For patients For Staff For Metro South

PD management information available at ALL TIME Diminish number of visits Reduce PD related admissions To avoid unnecessary visits To ease the calculation of average removed fluid (ultrafiltration) Reduce transfers Prevent confusion on agreed treatment Access to current medic list, BP, BG, photos

• n exit site

PD-Buddy is unique Reminder on medication/med. changes Direct contact through mobile phone Commercializing opportunity Access to family /carers (if permission) Monitoring home dialysis always biggest challenge for PD units Feeling of support Time-consuming Exercise book 100% own smartphone willing to use it

Measuring the outcomes

Measurement Current state at Logan Target measure

Duration of visit in clinic 113 minutes (2016) 25% time reduction Peritonitis 1:24 patient-months (2015) (1:18 is acceptable) Equal or greater 1:25 Number of visits (nurse reviews) ~ 49 patients / month Reduction of 30% PD- related patient hospital admissions 39 PD-related hospital admissions (2015) To reduce the rate by 10%

The technology: PD-BUDDy platform

Data capture: Fluids management (PD ultrafiltration volume, fluid intake), BP, BGL, Weight, Exercise, Digestive Health, symptoms…. Medication management Appointment scheduling Educational multimedia content deliver electronic reminders Photo up load function

Web portal

• Access to clinicians through a standard web browser
• Clinicians may view clients’ progress at any time and

provide individualised feedback

• Password protected
• Enables to assess weekly progress and early care

intervention

• Data can be reviewed during PD Unit appointments to

aid in discussions with patients.

• Collaboration between the MSHHS and CSIRO’s AEHRC
• Study design: Open label pilot study to determine feasibility
• Study setting: The Logan Hospital Peritoneal Dialysis Unit
• Study population: 30 patients will be recruited in 3 months
• Duration of the project: 12 months
• Timeline:

Scoping, preparation and technique development (2-3 months) Establishing technical requirements; Ethics applications; Clinical portal development; Smartphone App development. Pilot study (10 months)

The PD-BUDDy study

I. Determine the use (data logs) and user perceptions (responses to user surveys)

• II. Reduce the patient time spent at clinic appointments
• III. Reduce PD related peritonitis

AIMS of this Pilot study are

Historic data for comparison will be obtained through retrospective analysis of an equivalent number of medical records for patients who have been on PD at 12 months prior to the start of the study and who are not included the current study

Outcomes so far

• App and web portal have been developed and tested.
• 16 patients recruited up until now..
• Preliminary feedback from staff and patients is extremely positive:
• Nominated for conference presentations and awards…

Nominated For Individual Board Award

Jun’17 Metro South Health Board

Invited to Present

Sep’17 Australian and NZ Society of Nephrology Annual Scientific Meeting

People’s Choice Award Jun’17 Renal Society of Australasia Conference

Lessons Learnt

• Patients with chronic illness experience difficulty with maintaining home based

therapy related documentation

• Most patients own a smart phone and are willing to change the way they

document their treatments regardless of demographics

• Collaboration (external organisations, medical colleagues and the hospital

executive ) is necessary

• Contractual process between the organisations may be a lengthy process
• Staff value potential change benefits and must be actively involved in the

change process

Study Investigator(s) and Key contact

Principal Investigator: Dr Ken-Soon Tan Director of Nephrology. Nephrology Unit Logan Hospital Co-Investigators: Mrs Marnie Budd Clinical Nurse. Peritoneal Dialysis Unit Logan Hospital Mrs Robyn Rogers Clinical Nurse Consultant. Peritoneal Dialysis Unit Logan Hospital Dr Marlien Varnfield Research Scientist Australian eHealth Research Centre, CSIRO Royal Brisbane and Women’s Hospital For more information Key Contact: Marnie Budd Email: marnie.budd@health.qld.gov.au Name: Robyn Rogers Email: robyn.rogers@health.qld.gov.au Acknowledgements: