#2933 Quality of care in patients after kidney transplantation with or without telemedicine
Authors: Duettmann Wiebke , Pohl Nathan Andreas , Zukunft Bianca , Osmanodja Bilgin , Halleck Fabian , Naik Marcel , Eleftheriadis Georgios , Hansen Carla Maria , Choi Mira , Bachmann Friederike , Hoegl Caroline , Budde Klemens 
Published: May 2024

Abstract

Background and Aims
Patients after transplantation require special attention to avoid complications. This includes trained medical doctors but also adherent patients and the integration of other health provider. eHealth products have the potential to improve medical care further. Therefore, we established a telemedicine module in addition to the standard care, which is ongoing since 2019. Patients receive a smartphone app to provide vital signs, confirm the intake of medication and have access to their laboratory values, current medication plan and a medication alert. A telemedicine team values the incoming data and acts if needed (www.maccs-projekt.de). In this study, we want to evaluate how satisfied patients are with telemedicine compared to patients receiving standard care only.

Method
This is a monocentric and prospective cross-sectional study including a set of questionnaires. We have a positive decision of ethics committee at our center. The study started 2020 and is still ongoing. We ask patients with appointments at our center for participation. If a signed consent is available, patients receive a set of questionnaires. We choose the ZAPA (https://www.kbv.de/media/sp/ZAP_Fragebogen_Englisch.pdf) and ZUF-8 (https://gfqg.de/forschung/assessment/zuf-8), both validated questionnaires, to evaluate the quality of care.

Results
Demographic data:
To date 247 patients participate, 156 (63.2%) with additional telemedicine and 91 (36.8%) as control (68% male). Median age is 57 years (±13.59 years). The youngest participant in the study is 21 years old, and the oldest is 85 years old, resulting in an age range of 64 years.
In this population, the data indicate the following primary causes for transplantation: IgA Nephropathy (18.1%), ADPKD/Polycystic Kidney Disease (16.5%), unknown aetiology (8.6%), Chronic Glomerulonephritis (6.6%), and Focal Segmental Glomerulosclerosis (4.1%). Collectively, these conditions account for 53.9% of the underlying diseases leading to transplantation in this cohort.
All patients are kidney recipients, 24 patients (9.7%) received a second kidney transplant, while only three patients (1.2%) received three kidneys. Nine patients (3.6%) had a mono pancreas transplantation, three patients (1.2%) received two pancreas and one patient (4%) had three pancreas transplantations. Two patients (8%) received a liver transplantation. The median after kidney transplantation is eleven years (± 9.4 years). The maximum of a functioning kidney is currently 39 years.
Questionnaires:
The ZAP evaluates the satisfaction of patients with their outpatient care centers. The questionnaire has five categories measuring various aspects of medical care (scale 0 to 100 points, higher values indicate greater satisfaction). The results are shown in Table 1. In average 94.7 to 96.8% of patients participated on this test.
The questionnaire ZUF-8 evaluates the satisfaction of patients with the current care (every kind of care can be estimated). ZUF-8 includes eight questions and has a range of eight to 32 points. Higher sums indicate better satisfaction. The telemedicine group had a mean of 28.6 points (±3.2 points) and the control group a mean of 28.8 points (±3.4 points).

Conclusion
All over, patients are highly satisfied with the standard care after transplantation at our center. Patients with access to telemedicine seem to benefit from help regarding organization of their treatment plan. The data indicate trend to better doctor-patient interaction and cooperation of the doctor to support patients, although testing for significance could not rule out the null hypothesis. As the trial is still ongoing, we plan further evaluations with more participants.