Thursday, March 28, 2013

Tele-Nephrology? Pros and Cons

Telenephrology may contribute to an effective use of health facilities by allowing patients to be treated in primary care with remote support by a nephrologist. A recent study done in Netherlands showed that telenephrology consultations( done via phone remotely or video conferencing) looked at reduction of in person referrals and response time. Time investment per consultation amounted to less than 10 minutes. Consultations were mainly performed during office hours. Response time was 1.6 days.  Most questions concerned estimated glomerular filtration rate, proteinuria, and blood pressure. The authors concluded that a web-based consultation system might reduce the number of referrals and is usable. Another study done in Russia also shows some promise.  A nice study from Canada showed that a positive response. The analysis of staff hours worked showed almost no increase following the introduction of telemedicine. Telemedicine is therefore feasible for follow-up care of remote chronic kidney disease patients.
Peritoneal dialysis seems to be a place where this might be very useful or home dialysis. Few papers have looked into positive aspects of this form of medicine. Remote monitoring of the patient on peritoneal dialysis offers the benefits of real-time monitoring and recording of the therapy and interactive interface with the nephrology team can allow both acute 'trouble shooting' for problems as well as a means to interact with the patient for their monthly evaluation. This remote monitoring may increase compliance. Recent advances in telemonitoring, remote network access and sensor technologies have made such remote monitoring of peritoneal dialysis therapy a potentially user friendly option. A recent review summarizes the pros and cons of using such techniques.
Other studies have shown otherwise. In France, the experience seemed unfruitful and had to be shut down.

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