Judy Tan1, Anita Mehrotra2,3, Girish N Nadkarni2, John Cijiang He2,3, Erik Langhoff2,3, James Post2,3, Carlos Galvao-Sobrinho4, Henry C Thode5, Rajeev Rohatgi6,7. 1. Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. 2. Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. Division of Nephrology, James J Peters Veterans Affairs Medical Center, Bronx, New York, USA. 4. Ascension-Columbia St. Mary's, Department of Medicine, Columbia West Clinic, Wauwatosa, Wisconsin, USA. 5. Department of Emergency Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA. 6. Division of Nephrology, Northport VAMC, Northport, New York, USA. 7. Division of Nephrology, Stony Brook University School of Medicine, Stony Brook, New York, USA.
Abstract
BACKGROUND: Chronic kidney disease (CKD) patients who live far (>30 miles) from their nephrologist experience lower rates of clinic visit adherence, limited access to treatment, and higher rates of hospitalization and mortality than patients who live in close proximity to their nephrologist. Strategies to minimize disparities between urban and remotely located CKD patients are needed. The purpose of this study was to determine whether adherence to clinic visits and clinical outcomes in the remote management of CKD via telenephrology is comparable to in-person conventional care. METHODS: Renal clinic adherence and composite outcomes of death, end-stage renal disease (ESRD), or doubling of serum creatinine (Cr) were measured in geographically remote Hudson Valley VA Medical Center (HVVAMC) CKD patients enrolled in telenephrology (n = 112) and CKD patients enrolled in the Bronx VAMC renal clinic (n = 116). RESULTS: Prior to implementing the telenephrology service, 53.1% of scheduled visits of rural HVVAMC patients to the Bronx VAMC renal clinic were either cancelled or were "no-shows." This was reduced by nearly half (28.5%) after instituting telenephrology (p < 0.001). Moreover, the frequency of attending appointments was greater in the telenephrology (71.9%) vs. in-person Bronx VA cohort (61.0%). The incidence of the composite outcome of death, ESRD, or doubling of Cr was similar between both groups (p = 0.96) over 2 years of follow-up. CONCLUSIONS: Remote CKD care delivered through telenephrology improves renal clinic visit adherence while delivering comparable renal outcomes. Application of this technology is a promising method to provide access to care to rural CKD patients and to minimize the disparity between urban/rural patients. Published by S. Karger AG, Basel.
BACKGROUND:Chronic kidney disease (CKD) patients who live far (>30 miles) from their nephrologist experience lower rates of clinic visit adherence, limited access to treatment, and higher rates of hospitalization and mortality than patients who live in close proximity to their nephrologist. Strategies to minimize disparities between urban and remotely located CKDpatients are needed. The purpose of this study was to determine whether adherence to clinic visits and clinical outcomes in the remote management of CKD via telenephrology is comparable to in-person conventional care. METHODS: Renal clinic adherence and composite outcomes of death, end-stage renal disease (ESRD), or doubling of serum creatinine (Cr) were measured in geographically remote Hudson Valley VA Medical Center (HVVAMC) CKDpatients enrolled in telenephrology (n = 112) and CKDpatients enrolled in the Bronx VAMC renal clinic (n = 116). RESULTS: Prior to implementing the telenephrology service, 53.1% of scheduled visits of rural HVVAMC patients to the Bronx VAMC renal clinic were either cancelled or were "no-shows." This was reduced by nearly half (28.5%) after instituting telenephrology (p < 0.001). Moreover, the frequency of attending appointments was greater in the telenephrology (71.9%) vs. in-person Bronx VA cohort (61.0%). The incidence of the composite outcome of death, ESRD, or doubling of Cr was similar between both groups (p = 0.96) over 2 years of follow-up. CONCLUSIONS: Remote CKD care delivered through telenephrology improves renal clinic visit adherence while delivering comparable renal outcomes. Application of this technology is a promising method to provide access to care to rural CKDpatients and to minimize the disparity between urban/rural patients. Published by S. Karger AG, Basel.
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