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 1. Presentation of the AEHRC’s mobile -health platform 2.Provide an example of m-Health supporting chronic disease management: The PD-Buddy platform Dr. Manuel Gonzalez Garcia Australian eHealth Research Centre (AEHRC ) 2

Delivery of healthcare interventions using mobile computing platforms HIC 2017| Manuel Gonzalez Garcia| AEHRC

The AEHRC m-Health platform The whole system Smartphone application Web portal

Our m-Health platform is different…

Patient comments … Clinician comments… “The MoTER program is the “Recording and seeing preferred option for patients “I wish the program who are shift workers, live in weight and blood went for longer” rural areas, have transport pressure every day helped issues , or for patients who are me to be more motivated the main carer for a loved one” to exercise and be more “The MoTER “The MoTER program active” program has huge gave me a better potential to understanding of my provide a home disease” based care” “Clients appreciate “Someone to the individualised talk to if any attention” issues”

M- Health….. The future

The disease Chronic kidney disease (CKD) loss of kidney function that occurs over a prolonged course of time • 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

PD: Peritoneal dialysis • 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 The use of PD to manage CKD requiring The graph shows the growth of PD patients at dialysis is growing significantly, both as the Logan hospital since opening of the service in 2011 first dialysis modality and within 6 months to 2014. of starting dialysis (ANZDATA, 2016). 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 Time wastage Appointment non- • Time consuming for patients adherence • Inefficient use of time spent attempting to gain accurate information EXERCISE BOOK Books are often lost or not brought into clinics Not aligned with current X 4 available technology Growing population Confusion • Information overload • Incomplete documentation

Proposed Solution The majority of patients never forget to bring their phone to PD clinic visits “The customisation of the CR platform to deliver care components to PD individuals, support them in their home-setting and enhance PD service delivery” Innovative technology • Increase patient satisfaction and engagement • Reduce time spent at clinic appointments • I mprove communication channels and documentation process

Proposed Benefits For patients For Staff For Metro South Diminish number of visits Reduce PD related admissions PD management information available at ALL TIME To avoid unnecessary visits To ease the calculation of average removed Reduce transfers fluid (ultrafiltration) Access to current medic list, BP, BG, photos PD-Buddy is unique Prevent confusion on agreed treatment on exit site Direct contact through mobile phone Commercializing opportunity Reminder on medication/med. changes Monitoring home dialysis always biggest Access to family /carers (if permission) 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 113 minutes (2016) 25% time reduction Duration of visit in clinic 1:24 patient-months (2015) (1:18 is acceptable) Equal or greater 1:25 Peritonitis ~ 49 patients / month Reduction of 30% Number of visits (nurse reviews) 39 PD-related hospital admissions (2015) To reduce the rate by 10% PD- related patient hospital admissions

The technology: PD-BUDDy platform

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

Web portal • Access to clinicians through a standard web browser • Password protected • Clinicians may view clients’ progress at any time and provide individualised feedback • Enables to assess weekly progress and early care intervention • Data can be reviewed during PD Unit appointments to aid in discussions with patients.

The PD-BUDDy study • 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)

AIMS of this Pilot study are 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 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… People’s Choice Award Jun’17 Renal Society of Australasia Conference 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

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: For more information Key Contact : Dr Ken-Soon Tan Director of Nephrology. Nephrology Unit Marnie Budd Logan Hospital Email: marnie.budd@health.qld.gov.au Name: Robyn Rogers Co-Investigators: Email: robyn.rogers@health.qld.gov.au Mrs Marnie Budd Clinical Nurse. Peritoneal Dialysis Unit Logan Hospital Acknowledgements: 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