Improving Adherence in Renal Dialysis Patients Through Electronic Interventions
Condition: Endstage Renal Disease
MeSH terms: Kidney Failure, Chronic
Study type: Interventional

Summary: 
      Dialysis treatment non-adherence is a prevalent problem among the end-stage renal population
      receiving chronic hemodialysis. The complications associated with missed or shortened
      dialysis sessions are serious and frequently require emergent medical care or
      hospitalization. Previous studies have shown that electronic messages have significantly
      improved attendance rates in a primary care setting, but these messages have not been
      validated in the chronic dialysis population.

      An electronic intervention has been developed by Epharmix, a WUSTL IDEA Labs
      (ideas.wustl.edu) team, which has the capacity to use automated SMS text messages and/or
      phone calls to notify patients prior to each upcoming appointment, as well as alert a
      designated patient advocate. Patients receiving the messages are provided with key contact
      information for a dialysis rescheduling phone line, transportation resources, social work
      services, etc. They may also receive instructions on what to do if they are experiencing
      physical symptoms and need educational facts about dialysis. In particular, the intervention
      is designed to demonstrate to patients that the center cares and is concerned for their
      health and wellbeing. This intervention may potentially improve patient adherence to their
      scheduled sessions, increase patient satisfaction with their treatment, and prevent medical
      complications associated with missed dialysis appointments.

      This study aims to determine whether an electronic intervention, which sends SMS text
      messages or phone calls of key dialysis treatment information, is able to improve dialysis
      treatment session attendance among dialysis patients with a history of poor attendance. We
      secondarily aim to identify the factors that may be barriers to dialysis treatment session
      attendance and the emergency department or hospital utilization associated with missed
      dialysis treatments.

      Patients will be prospectively identified, recruited, and randomized into two groups. Group A
      will receive the electronic intervention prior to their appointments; Group B will not
      receive any electronic intervention. After 8 weeks, crossover will occur for both groups and
      the study will continue for an additional 8 weeks. Participants' clinic records will be
      reviewed to determine the numbers of missed and attended appointments, as well as records of
      ED visits and hospital admissions. Subjects will be asked to complete a post-study
      satisfaction questionnaire.
    

Detailed description: 
      Dialysis treatment non-adherence is a prevalent problem among the end-stage renal population
      receiving chronic hemodialysis. The complications associated with missed or shortened
      dialysis sessions are serious and frequently require emergent medical care or
      hospitalization. Previous studies have shown that electronic messages have significantly
      improved attendance rates in a primary care setting, but have not been validated in the
      chronic dialysis population.

      An electronic intervention has been developed by Epharmix, a WUSTL IDEA Labs
      (ideas.wustl.edu) team, which has the capacity to use SMS text messaging to phone call
      recordings to notify patients prior to each of their upcoming appointment times, with the
      option of also alerting a designated patient advocate. Patients receiving the messages are
      provided with key contact information for a dialysis rescheduling phone line, transportation
      resources, social work services, etc. This intervention may potentially improve patient
      adherence with scheduled sessions, increase patient satisfaction with their treatment and
      prevent medical complications associated with missing dialysis.

      This study aims to determine whether an electronic intervention, which sends SMS text
      messages or phone calls of key dialysis treatment information, is able to improve dialysis
      session attendance among patients with a history of poor attendance. Our secondary aim is to
      identify factors that may be barriers to dialysis appointment attendance and are associated
      with emergency department (ED) or hospital utilization.

      Procedures: Dialysis patients of the Chromalloy American Kidney Center (CAKC) at Barnes
      Jewish Hospital (BJH) and the Washington University Dialysis Center (WUDC) will be included
      in this study. Two cohorts will be prospectively identified, one group consisting of
      individuals with a history of occasional non-attendance to treatment sessions, defined as 2-3
      missed sessions out of 24 consecutive sessions in the past 8 weeks; the other group
      consisting of individuals who are frequently non-adherent (4-6 missed sessions in the past 24
      consecutive sessions). Patients from each cohort will be recruited and then randomized to
      either the experimental or the control group. Group A will receive the electronic
      intervention featuring automated SMS text message and/or phone call prior to their
      appointments; Group B will not receive any electronic intervention. After 8 weeks, crossover
      will occur for both groups and the study will continue for an additional 8 weeks.

      At time of enrollment, all subjects will be asked to complete a questionnaire to determine
      the demographic characteristics of the study population of interest and identify possible
      socio-economic factors contributing to non-adherence to the prescribed 3 times weekly
      dialysis schedule. The participants' clinic records will be reviewed to determine the numbers
      of missed and attended appointments, as well as records of ED visits and hospital admissions
      through BJH. Subjects will be asked to complete a post-questionnaire to rate their
      satisfaction with their current schedule of dialysis and their satisfaction with the
      electronic intervention.
    

Intervention name(s): EpxDialysis
Intervention type(s): Other
Intervention description(s): The EpxDialysis intervention consists of automated SMS text or voice messages delivered to the patient's preferred phone number three times per week. These messages provide details about the subject's upcoming hemodialysis session, anticipatory guidance regarding clinically-concerning symptoms, as well as the option for direct call routing to the dialysis center for rescheduling sessions.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: eHealth; mHealth; Hemodialysis; Adherence; Electronic intervention; ESRD; Nephrology