MO885APP BASED DOCUMENTATION AND SUPPORT OF A GERMAN HOME DIALYSIS PROGRAMM - A PILOT STUDY
Authors: Schricker Severin , Schanz Moritz , Oberacker Tina , Merz Silke , Kimmel Martin , Alscher Dominik M , Ketteler Markus 
Published: May 2021

Abstract

Background and Aims
Telemedicine is advancing. However, studies that examine the integration into home dialysis care are still scarce. This multicenter, Germany-wide prospective observational pilot-study investigated the effects, acceptance and usability of an app as a new care concept compared to conventionally cared-for patients.

Method
Here, we employed the “DiaApp”, a tablet based documentation, communication, information and supply ordering system developed by the PHV – a non-profit dialysis network in Germany with around 7,000 patients. During a pilot rollout phase of the app between 2018 and 2019, 25 patients participated in four dialysis practices. Participants were free to choose between app use (app) and the previous paper-based documentation (control). We collected prospective data on demographics, adverse events as well as questionnaires regarding quality of life (KDQL v1.3), affinity for technology (TA-EG), satisfaction with the app (UTAUT), and self-confidence in dealing with chronic illness (SES6G). Furthermore, 5 app users were interviewed in a qualitative interview over 90 min about their attitude towards technology, illness and the app.

Results
Of the 25 participants, 13 used the app (52%). App users tended to be younger, more likely to be male (60.0%) and on peritoneal dialysis (n=15, 60.0%). Median age and dialysis vintage for app users and controls were 51 (38-60; 0) vs. 59 (37-64; 1) years and 51.5 (34-68; 3) vs. 38 (28-66; 5) months, respectively. Mean follow-up durations were 6.5 months and 12 months. All participants continued to use the app. One exit site infection (app), 3 hospitalizations (peritonitis and shunt revision, controls; inguinal hernia, app) and no serious app-related adverse event occurred.
App users exhibited small trends (n.s.) towards lower quality of life (median SF-12 physical composite app: 43, IQR 40-48 controls: 47, IQR 38-50; SF-12 mental composite median app: 53, IQR 35-55; controls: 56, IQR 42-59;) greater self-confidence in managing chronic illness (SESG6 Score app: 7.33, IQR: 6-8.83; controls:7.17, IQR 6-7.83) and higher affinity for technology (in all four TA-EG dimensions). App users were more likely to have completed a master’s degree, while non-users mostly had a bachelor's degrees (Chi-square 14.183, df 6, p=0.028). Overall, the educational level of participants was high. There was a tendency (n.s.) for actual app users to have slightly lower performance expectations (median control arm 5.5 vs. app arm 5.88 on a Likert scale 1-7), a slightly higher assessment of their own and other available resources (supportive conditions median control arm 6 vs. app arm 6.67 on a Likert scale 1-7).
In the qualitative interviews, all app users surveyed stated that they regularly used digital offerings in all areas of their lives. Therefore, expectations were similar to other apps to be more efficient in terms of time, material and effort than paper-based documentation. The attitude towards the app was that towards an auxiliary tool, “it should simply work”, and found it to be useful. Patients disliked the necessity of a dedicated (in this case a tablet) device for running the app. Information about the disease was more likely to be outside of the app in e.g. the internet.

Conclusion
In this study, we found no significant differences between app users and controls. No adverse events occurred. Via trends and interviews, the picture emerges that an upcoming, younger generation of dialysis patients appreciates the advantages of flexible home dialysis procedures and, as in other areas of life, expects simple, digital and thus resource-saving options for self-management and communication. At the same time, such applications are also subject to the expectations of digital user experiences from other areas of life. This poses enormous challenges for the often-costly development of such applications by non-commercial providers and limited number of target audiences.