Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 20, 2019
Date Accepted: Mar 22, 2020
Date Submitted to PubMed: Mar 22, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Social Networking Services Enhanced Smart Care Model: New theory from Chronic Care Model for Chronic kidney disease stage V
ABSTRACT
Background:
CKD stage V is a high risk for dialysis initiation and complication such as uremic encephalopathy, uremic symptoms, gastrointestinal bleeding and infection. IDEAL trial provides guidance on the safety of waiting for symptoms or lower levels of estimated glomerular filtration rate prior to beginning dialysis. There was a serious communication gap during CKD stage V care.
Objective:
Our aim was to establish a powerful care model with Social Networking Services(SMS) to improved care quality in health care and dialysis initiation.
Methods:
Our study is retrospective cohort from 2007 to 2017. The patient age is between 20-85 years. In 2014, Dr H started to use with SMS app to connect with CKD stage V patients and their family. In case of emergency, the patients and their family can report any condition to Dr H. Dr H help promote the “productive interactions” between CKD stage V patients and Healthcare system. End point is to delay initiation of dialysis therapy with safety. Patient divided to four group, Team during 2007 to 2014(Team), Dr H during 2007 to 2014( Dr H), Team without SMS(Team-mob) during 2014 to 2017 and Dr H with SMS(Dr H +mob).
Results:
In our study, 4 group patients have different time to dialysis. Before adjusting, Group “Dr H +mob” had longer time to dialysis (761.7 ±616.2 days) than another group (vs Team p=0.011*, vs Dr H p=0.039*, vs Team-mob p=0.049*) . After adjusting with baseline eGFR , “Dr H +mob” had prolonged more duration of each eGFR drop (84.8 ±65.1 days) than other group (vs Team p=0.005*, vs Dr H p=0.032*, vs Team-mob p=0.002**) .
Conclusions:
SMS in Chronic stage V patients and physician can resolve the gap of communication and create more benefits for Chronic kidney disease to delay initiation of dialysis. Therefore, the role of SMS and the associated care model should be further investigated in more large population. Clinical Trial: The study has been approved by the ethical review board of National Taiwan University Hospital approved this study (NTUH 201901030RINB and 201903005RINA).
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