The Development of Telemedicine for Caring Patient undergoing Peritoneal Dialysis: Lesson Learned from the COVID-19 Pandemic

Abstract

Background and rationale: Chronic kidney patients with renal replacement therapy were at risk of COVID-19. During COVID-19 pandemic with social distancing practices, hospitals postponed patient’s appointments. Methodology: The purpose of this mixed-method study was to develop and examine the effectiveness of telemedicine model in caring for peritoneal dialysis patients from lessons learned during the COVID-19 pandemic. The samples included 2 nephrologists, 6 pharmacists, 10 peritoneal dialysis nurses, and 80 peritoneal dialysis patients. Purposive sampling was used to select the participants. The study comprised 3 phases: phase 1 situation analysis; phase 2 design and development of a model of telemedicine service for peritoneal dialysis patients; and phase 3 result study of the telemedicine model by comparing the treatment time, cost and satisfaction. The research instruments covered a semi-structured interview guide, feasibility questionnaire of telemedicine model, cost record form, and satisfaction questionnaires for multidisciplinary team and peritoneal patients and caregivers. The quantitative data was analyzed using descriptive statistics, Wilcoxon signed-rank test, and paired t-test. Results: 1. During COVID-19 pandemic, patients and their caregivers have difficulty getting to the hospital as scheduled, the continuity of taking medication and the limitation of home visits. Patients and multidisciplinary teams suggested that during COVID-19, the methods of care should be adjusted, using telephone online platforms, such as Line application, to provide patients and caregivers the knowledge to promote self-care. The applications should be downloaded onto a mobile phone for immediate communication with the doctor and nurse when abnormal symptoms and problems were found. 2. According to patients and care providers, the feasibility of a telemedicine model in caring for peritoneal dialysis patients was moderate at the beginning. The model was rated highly by the multidisciplinary team, patients, and caregivers at the conclusion of the intervention. 3. Three patterns of patient journeys of peritoneal dialysis patients were identified based on clinical status of the patients: a well-controlled, a moderate control, and an uncontrolled symptom group. and 4. medication management of erythropoietin (EPO) and other medications for chronic kidney disease and co-morbidities were delivered through a nearby client hospital network. Discussion and conclusion: The cost of telemedicine model incurred higher capital costs at periphery. The higher number of services should lower the unit costs. Telemedicine was proved to be a feasible model of providing care among patients who had good disease progression control and reducing hospital visits. Therefore, the health service may develop and expand the results of this study to other chronic diseases. The provider should combine telemedicine with outpatient service.