JMIR Publications

ABSTRACT

Background:

Chronic Kidney Disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow progression to end stage kidney disease, requiring renal replacement therapy. However, adherence to these recommendations is often low.

Objective:

The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV).

Methods:

A two arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial (RCT), running in two NHS sites in the UK. Sixty-one patients with CKD were randomized 1:1 into two groups and provided with either a new tailored, digital support program (CareKnowDo, n = 31) integrated with PV, or standard care (PV alone, n = 30). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based; recruitment rate, drop-out, and exploration of associations.

Results:

Out of 1,392 patients screened in local kidney clinics, 269 met the basic inclusion criteria, the first eligible 61 of whom were recruited to participate in the study. Twenty-three patients (37.7%) completed the final 6-month follow-up survey. Reasons for attrition are explored. Higher belief in the ability of treatment to control CKD was associated with lower blood pressure at baseline (r = .52, P = 0.005), and higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r = 0.66, P < .001). Beliefs about medicines at baseline were associated with blood pressure at baseline, but not at follow-up. This was true for both concerns about medicines (r = .A digital support program to enhance support for patients with CKD was piloted in two NHS sites, and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible.58, P = .001) and perceived necessity of medicines (r = .42, P = .03).

Conclusions:

A digital support program to enhance support for patients with CKD was piloted in two NHS sites, and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. Clinical Trial: Kidney disease, chronic; blood pressure; randomized controlled trial; telemedicine; mhealth; self-management; guideline adherence; medication adherence; illness beliefs; treatment beliefs; health psychology; preventative medicine; qualitative research