Currently submitted to: Journal of Medical Internet Research
Date Submitted: Aug 18, 2017
Open Peer Review Period: Aug 19, 2017 - Oct 14, 2017
Feasibility and Effectiveness of a Web-Based Portal for delivery of care to home dialysis patients.
Background: Quality of life in home dialysis patients is low compared to the general population. Improvement in patient satisfaction through shared decision-making and handling of patient requests through an online interface has been shown to be beneficial in some studies in other disease populations. Such a system may improve patient satisfaction, reduce health service utilization and potentially improve health outcomes.
Objective: To determine the acceptability, practicality, and implementation of an eHealth patient portal in home dialysis patients.
Methods: Prospective feasibility cohort study among patients receiving either home hemodialysis or peritoneal dialysis over a four-month period. Web-based application allowing patients and healthcare workers to communicate through a secure, password protected online portal and permits visualization of the messaging history by patient and provider. Patients and the home dialysis healthcare team had the ability to send messages related to patient care at any time. Messages could be sent between the healthcare team and patient including proposed changes to medication, instructions after a clinic visit, times of new appointments, upcoming investigations or questions about care. Consumer Quality Index (CQI), Quality of Life using the EuroQol Five Dimensions Questionnaire, acceptability and satisfaction using online Acceptability E-scale and Satisfaction questionnaires. Patients were assessed at baseline and at 6 and 12 months of followup.
Results: Of the 41 patients who consented to join the web-based portal, 27 (66%) created an online account. Mean CQI for the Nephrology domain was 3.50 (95%CI: 3.33,3.67) and this did not change significantly over the study period. Quality of life using the EQ-index score was 0.80 (IQR: 0.71-0.83) at baseline and this also did not significantly change over the study period. The web-based portal was easy to use with a median response of 4 (IQR: 4-5). Most were satisfied with a mean score of 6.5±0.6 in overall satisfaction.
Conclusions: In this study of home dialysis patients, we identified that an online portal for care-delivery was feasible. We did not find a significant improvement in CQI or QOL, but the portal was felt to be beneficial at addressing some domains of patient care.
Trial Registration: ClinicalTrials.gov number NCT02128347