Mi Kidney App for Chronic Kidney Disease

Introduction

The Renal Department at SJH have designed and developed a Smart Phone Application called MiKidney to assist patients with chronic kidney disease (CKD) to self-manage their disease.

Objectives

1. Empower patients with chronic kidney disease (CKD) to become more engaged in the management of their condition through Smart Phone Technology using an application (App) called MiKidney.
2. Provide the necessary information and education to enable patients to identify and manage the risk factors associated with CKD and subsequently slow the progression of the disease.
3. Provide the necessary information and education to promote a healthy lifestyle for patients with CKD and enable them to manage the physical, psychosocial, pharmacological, and nutritional aspects of CKD.
4. Improve the quality of patient-physician interactions at the outpatient clinic.
5. Potentially reduce the additional healthcare costs associated with dialysis by slowing the progression of CKD through improved patient information and education. According to Kerr et al (2012), the average annual cost for dialysis treatment is £24,053GBP per patient.
6. Increase access of patients, family members, and carers to information, advice and support irrespective of their geographical location. Our aim is to increase the accessibility to information and services for all patients as they navigate their way through the illness journey of CKD.

Implementation

November 2014
Patients were invited to attend a focus group to discuss their experiences of the renal service in SJH and assess their healthcare needs. Based on the findings of this group, a Smartphone App called MiKidney was created to address the needs identified. These included personal medical information records such as medical history & medical alerts on their phone; provide information about Chronic Kidney Disease (CKD), and on the dietary restrictions associated with CKD; Track blood results and blood pressure readings on a trend graph; Record patient’s specific medication list and information on the most common medications for CKD; Provide an exercise tracker and exercise information; Provide information to assist patients in promoting a healthy lifestyle.

January 2015 – Sept 2015
A nurse project team was set up and tendered through the hospital for companies to design and build the App. Other members of the multidisciplinary team, including a dietitian and physiotherapist, became actively involved in the development process. The patients included in the focus group were invited to review the design of the App and provide feedback. With the App still under construction, the benefits were already evident. Many patients appeared interested and more motivated and positive towards their condition. Regular updates were given to the focus group patients. This ensured that there was high awareness of the App development. It was agreed that once the App was created, a group of patients with CKD would participate in a 12 week pilot study.

September – November 2015
Meetings were held with the Irish Kidney Association and the National Renal Office (NRO) to gain their insights and opinions. Feedback suggested that the development of this initiative could have the potential to save significant costs in Ireland. A second patient information evening was held to keep patients informed of developments and also to identify patients who might be willing to be included in the pilot study. This meeting was attended by 65 people.

January 2016
A meeting was sought with Vodafone Head Quarters to to discuss the 12 week pilot study. They were eager to become involved and offered free smartphones and reduced tariffs to all patients. Vodafone also agreed to facilitate technological assistance for patients downloading the App to their own phones.

May 2016
Launch of MiKidney Food & Exercise Diary, which is part of the App. Adherence to a strict diet plays a significant role in the well-being of the patient with CKD. Patients suggested the App allow them to set weekly goals for exercise and also keep a record of their renal diet. They would keep this diary as part of the 12 week pilot study.

May 2016- July 2016 - Pilot Study Phase

1. The pilot study to trial the App was conducted by the Renal Department in collaboration with Trinity Centre for Practice and Healthcare Innovation, at the school of Nursing and Midwifery (TCD). A total of 24 patients participated in the pilot study1. All participants were given a Vodaphone Smart Phone along with a food and exercise diary, and instructions on how to use the App. Each patient received help from the Nursing Team with inputting their personal medical information and medication lists. They were shown how to input their blood data and use the App for setting medication reminders and hospital appointments. The pilot study involved three visits over 12 weeks - week 1 (Baseline), week 6 (Midway) and week 12 (End).

Outcome

August 2016 - Initial results from the pilot project

Participants in the pilot study were at various stages of kidney disease and had a diagnosis of CKD ranging from one year to 25 years with over half being diagnosed for 10 years or more. Overall, the participants found using the App a very positive experience. Since using the App participants indicated that they had a better understanding of their condition, were more likely to take their medication as prescribed, include healthier foods in their diet and take regular exercise.

45% of participants displayed a reduction in their BMI over the 12 weeks while 40% remained the same.

Average body fat (%) reduced from 29.7% at baseline, to 28.1% post intervention.

Over half (54.4%: n=6) of participants increased their walking distance measured by the six-minute walk test.

Half of participants (50%) used the exercise tracker, 60% used the food diary and 60% the medication reminder.

Obesity levels improved with the use of the MiKidney App. Almost three quarters (65%, n= 13) of participants were overweight at baseline (overweight (n=5): obese (n=7); morbidly obese (n=1)). This improved to 55% (n=11) with no participants in the morbid obesity category post use of application.

Qualitative results reveal the MiKidney application was viewed very positively.

Conclusion

This is the first phone application designed for CKD patients in Ireland. The APP facilitates a change of ethos in the provision of a supportive care approach, which combines high tech medical care with the psychosocial aspects of care. The participatory action research approach ensures patients are active participants throughout the process. The success of this APP is largely due to the MDT who worked collaboratively to ensure the desired changes in practice were implemented in a timely fashion.

It is proposed that the implementation of changes in practice combined with the participatory action research methodology makes our project a unique endeavour with substantial merit.