Bridging “Office-Based Care” With the “Virtual Practice Care Model”: Evolving Care for Chronic Kidney Disease Patients in the COVID-19 Pandemic—And Beyond

Frontiers in Medicine

article

Bingbin Zhao¹  Xia Hong²  Winfred Williams³  Limeng Chen¹  Lei Zhang¹  Peili Ji¹  Jianfeng Lin¹  Jianfang Han⁴  Jiaying Li¹  Zijuan Zhou¹  Haiyun Wang¹  Ling Qiu⁵ 

[1] Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences;Department of Psychological Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences;Department of Nephrology, Massachusetts General Hospital and Harvard Medical School, United States;Department of Nephrology, Qinghai Provincial People's Hospital;Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences

关键词: chronic kidney disease;    telemedicine;    coronavirus;    psychological stress;    patient care;   

DOI  :  10.3389/fmed.2020.568201

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY