Video-based telemedicine used to facilitate care across all kidney disease stages

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Video-based telemedicine is used to facilitate care across all stages of chronic kidney disease (CKD) and has evolved in recent years to be less reliant on specialised equipment, allowing patients to receive kidney care in a location of their choice. Further work is still needed on approaches to sustainable integration and minimising barriers to access in this space, however.

These are among the key findings of a recent review of published studies intended to provide an overview of the available evidence on the implementation and outcomes of using video-based telemedicine for adults across the spectrum of kidney disease over time. Details of the review are published in the Clinical Journal of the American Society of Nephrology (CJASN).

A team led by Ann Young (St. Michael’s Hospital of Unity Health Toronto, Toronto, Canada) and Stephanie W Ong (University Health Network, Toronto, Canada) identified 24 studies published between 1997 and 2020 across 10 countries.

The investigators found that video-based telemedicine has been used to facilitate care across all stages of CKD—including earlier stage kidney diseases, dialysis and transplantation.

They also observed that, while earlier studies used institution-specific technologies that linked main hospital sites to more remote healthcare locations, recent studies saw the use of consumer-based platforms on personal devices that further removed geographic barriers. Video-based care was also well-received, with studies reporting acceptable clinical outcomes, improved efficiencies and high patient satisfaction.

“This is encouraging, but—as the latest technologies are streamlined into routine health care—the ‘digital divide’ will become more pronounced, negatively impacting those without access to broadband internet connections, video-capable devices, and those with limited technology literacy,” said Ong. “This is an area that deserves further study.”

On 13 October 2021, three Canadian health officials—Ontario’s chief medical officer of health, the assistant deputy minister for Ontario Health Insurance Planning in the Ministry of Health, and the registrar and chief executive officer of the College of Physicians and Surgeons of Ontario—sent a joint letter to physicians urging them to resume more in-person visits and to cut back on virtual appointments, noting that while virtual visits were encouraged earlier in the COVID-19 pandemic, pressures on the healthcare system have since eased.

“The nature of CKD care makes it particularly amenable to virtual care given that relevant history, review of laboratory investigations and counselling can all be conducted via virtual platforms,” said Young. “The main obstacle to virtual care is the lack of a physical exam. Virtual visits are a powerful tool, but in certain clinical settings, a physical exam is necessary. Finding the appropriate balance between virtual visits and in-person visits is key.”

An editorial accompanying the CJASN study notes that telehealth will remain an effective and important means of providing healthcare, but it is not an appropriate option for every patient or for every visit. The authors also stress that ongoing research will be important as the field progresses. “Additional observational and interventional studies will be needed to measure telehealth outcomes as its use evolves and technology continues to advance,” they write.

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