Abstract
Since the outbreak of the coronavirus epidemic, the “virtual” telemedicine has become a critical substitute for patient-provider interactions. However, virtual encounters often face challenges in the care of patients in high-risk categories such as chronic kidney disease (CKD) patients. In this study, we explore the patient's satisfaction and the practical effects of a newly established telemedicine program on CKD patients' care during the COVID-19 pandemic. Based on a prior version of an online patient care platform established in 2017, we developed a customized and improved online telemedicine program designed to specifically address the challenges emerging from the pandemic. This included an online, smart phone-based strategy for triage and medical care delivery and psychological support. We invited a total of 278 CKD patients to join the new platform during the pandemic. The subjects in group A were patients utilizing our old online CKD system and were historical users registered at least 3 months before the pandemic. A pilot survey interrogating medical and psychological conditions was conducted. Feedback on the program as well as a psychological assessment were collected after 1 month. In total, 181 patients showed active responses to the program, with 289 person-time medical consultations occurring during the study. The virtual care program provided a rapid triage for 17% (30 out of 181) patients, with timely referral to in-patient medical encounters for their worsening medical conditions or severe psychological problems. Nearly all patients (97.4%) believed the program was helpful. The number of symptoms (OR 1.309, 95%CI 1.113–1.541; P = 0.001) and being enrolled during the pandemic (OR 3.939, 95% CI 1.174–13.221; P = 0.026) were associated with high stress. During the follow-up, the high-stress CKD group at baseline showed a significant decrease in avoidance score (6.9 ± 4.7 vs. 9.8 ± 1.9, P = 0.015). In conclusion, during the pandemic, we established an online telemedicine care program for CKD patients that provides a rapid triage function, effective CKD disease management, and potentially essential psychological support.
Highlights
Since the start of the coronavirus pandemic, by April 2020 more than three million confirmed coronavirus disease 2019 (COVID-19) cases have been reported worldwide
In the context of the current pandemic, during the 3-month period from February to April 2020, we explored the outcomes after provision of free telemedicine services for 278 chronic kidney disease (CKD) patients in China
There was no difference in the age, gender, home location, primary disease, and CKD stages between groups with or without active response (Table 1), with the exception of the lesser number of enrollees with a diagnosis of diabetic kidney disease (DKD) in the active response group (8.7 vs. 18.6%; P = 0.017)
Summary
Since the start of the coronavirus pandemic, by April 2020 more than three million confirmed coronavirus disease 2019 (COVID-19) cases have been reported worldwide. A key feature of new, emerging healthcare delivery paradigms is the radical change in traditional management patterns for acute and chronic disease [2]. The number and frequency of non-urgent patient encounters such as elective surgeries (e.g., knee replacement), routine diagnostic procedures (e.g., colonoscopy), routine health maintenance follow-up visits, and even new medical consultations have seen dramatic reductions. For chronic kidney disease (CKD), one of the most common public health problems and one often associated with high rates of comorbidity and mortality, these changing care patterns present special challenges. Because of the coronavirus outbreak, in the first quarter of 2020, the year-over-year number of CKD outpatient visits of one group in the PUMCH renal division had decreased by 50%
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