Introduction:
Healthcare resources in developing countries are limited.A major proportion of patients are deprived of access to hospitals.There are many hindrances(financial,geographical etc) leading to infrequent follow up of hemodialysis patients.Ultimately,it leads to poor treatment adherence and increased complications.To address this,World Kidney Day Theme for year 2024 was “Kidney health for all – Advancing equitable access to care and optimal medication practice”.Hub and spoke model for hemodialysis patients in remote areas is a major step taken in this direction.Centralized hub provides timely interventions and support,resulting in enhanced patient outcomes and operational efficiency.We conducted a comparative analysis of patient outcomes,operational efficiency,cost effectiveness between dialysis centres with telemedicine model and those with only in-person visit .The hub-spoke telemedicine model demonstrated significant improvement in patient adherence,with 35% increase compared to in-person visit model.Significant proportion of patients achieved adequate blood pressure (BP) control in telemedicine group with comparable rates as observed in in-person visits,satisfaction rates were as high as 83% with alleviation of financial burden,travel time and distance barriers.These findings suggest implementing such model significantly benefits remote dialysis care by leveraging centralized expertise and real time monitoring capabilities.
Methods:
Retrospective study was done to identify patients who were given consultation through telemedicine platform at 37 peripheral dialysis centres(spokes)and those through in-person consultation at Nephrology clinic at Nizam’s Institute of Medical Sciences,Hyderabad (Hub hospital) during 6 months period from January 2024 to June 2024.Patients who who fulfilled the inclusion criteria were selected.Written informed consent was taken from all the patients.Sample size was 416 ,including 210 patients from peripheral dialysis centres and 206 patients from central hub centre.Various parameters including medication adherence,frequency of visits,complications (hypertension,anemia control,vascular access complications) were observed during study period.Telehealth usability questionnaire(TUQ),an internationally validated questionnaire was used to evaluate the efficacy of telemedicine consultations. All the patients were interviewed with validated questionnaire to assess telemedicine usability and acceptability.Pearsons Chi square test and two sided T-test were performed to analyze statistical differences in demographics,adherence data,blood pressure reductions,complication rates between patients who conducted their visit through telehealth or in person.A univariate analysis was performed with Pearson’s chi square test to compare differences in telemedicine usage,age ,gender,number of prior visits with those who were adherent versus those who were not. Data analysis was performed using SPSS software.
Results:
Both systolic BP and Dias BP improved in the two groups during the study period. There was no statistically significant difference in blood pressure reduction rates between both the groups,suggesting telemedicine model was as effective as in-person model.There was no significant difference in proportion of patients with complications rates(Intradialytic hypertension,severe anemia requiring blood transfusion,fluid overload) in telemedicine model.(9.2% vs 7.3%,p>0.05).There were no significantly increased hospitalization rates for patients in telemedicine group in comparison to in-person.(AOR -1.0,95% CI 0.98-1.02)Patients reported high rates of satisfaction (83%) with telemedicine in various aspects including usefulness,ease of use,reliability,satisfaction and effectiveness .A proportion of patients expressed preference for periodic in-person visits accompanied with regular telemedicine consultations for follow up.Pearson Chi square test revealed a significant difference in preference percentages with telemedicine mode being more preferred for regular consultations.Financial reasons and geographical barriers were the commonest reasons for the preference for telemedicine mode.Comprehensive physical diagnosis and accuracy of diagnosis were found to be the reasons in those preferring in-person visit.
Conclusions:
Medication adherence rates were higher for patients with telemedicine consultations as compared to in-person consultations.Frequent consultations in telemedicine ensured the better patient compliance.Adequate BP reduction was achieved in telemedicine group with reduced complications like intradialytic hypertension,severe anemia,volume overload ,comparable to in-person model.There was substantial satisfaction rate including ease of use in patients in telemedicine model especially for follow up visits.With huge number of patients from economically weaker strata requiring hemodialysis,financial burden and travel time becomes important parameter to consider.In our study,we found that there was significant reduction in financial burden on patients leading to increased adherence to treatment and follow up.Telemedicine can be a boon for patients on hemodialysis,especially for those living in remote areas and unable to do frequent hospital visits.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.