Evaluating the feasibility and acceptability of home-based urinalysis for albumin-creatinine ratio with smartphone technology: A quality improvement project

IF 1.5 4区医学 Q3 NURSING

Journal of renal care Pub Date : 2023-02-14 DOI:10.1111/jorc.12460

Nicola Thomas PhD, Catriona Ewart MA, Carolyn Hill MSc

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Abstract

Background

Despite albumin-creatinine ratio (urine) testing being recommended for detection of chronic kidney disease among adults with diabetes, testing rates are suboptimal.

Aim

We implemented and evaluated a quality improvement project in an inner-city diabetes population in London, UK to assess the feasibility and acceptability of implementing novel home-based urinalysis using smartphone technology.

Methods

After eligible patients were identified and consented, testing kits were sent to the patient's home. Test results and patient feedback were collected through the smartphone application. Focus group discussions were conducted to evaluate primary care staff perspectives on uptake and delivery of the service.

Results

In total 2370 patients agreed to take part. Of these, 1244 completed the test (61% of those eligible) and of these, 465 (37%) had clinically significant albuminuria. 98% of patients found the test easy or very easy to use. Staff in primary care found the service to be beneficial for patients, and reported ease of set up and minimal administrative processes. Concerns regarding barriers among patients with lower digital literacy and non-English speakers were raised although these concerns were not substantiated.

Conclusion

Home-based albumin-creatinine ratio urine testing may improve the testing rates of people with diabetes at higher risk of chronic kidney disease. This is important post-pandemic, as healthcare services are trying to return to pre-pandemic levels of care. The study also found that the use of smartphone technology in an underserved (deprived) community is feasible, despite reservations about levels of digital literacy and possible language barriers. Further evaluation of effectiveness and costs is required.

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评估利用智能手机技术进行白蛋白-肌酐比值家庭尿液分析的可行性和可接受性：质量改进项目。

背景：目的：我们在英国伦敦市中心的糖尿病患者中实施并评估了一个质量改进项目，以评估使用智能手机技术进行新型家庭尿液分析的可行性和可接受性：方法：在确定符合条件的患者并征得其同意后，将检测试剂盒送至患者家中。通过智能手机应用程序收集检测结果和患者反馈。此外，还开展了焦点小组讨论，以评估基层医疗人员对这项服务的接受程度和提供情况的看法：结果：共有 2370 名患者同意参加测试。其中，1244 人完成了测试（占符合条件者的 61%），其中 465 人（37%）有临床意义的白蛋白尿。98% 的患者认为该检测易于使用或非常易于使用。基层医疗机构的工作人员认为该服务对患者有益，并表示设置简单，行政程序最少。有人担心数字素养较低的患者和不讲英语的患者会遇到障碍，但这些担忧并未得到证实：家庭白蛋白-肌酐比值尿液检测可提高慢性肾病高危糖尿病患者的检测率。这在大流行后非常重要，因为医疗保健服务正在努力恢复到大流行前的水平。研究还发现，在服务不足（贫困）的社区使用智能手机技术是可行的，尽管人们对数字扫盲水平和可能存在的语言障碍持保留意见。需要进一步评估其有效性和成本。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of renal care Nursing-Advanced and Specialized Nursing

CiteScore

3.50

自引率

5.30%

发文量

期刊介绍： The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA). The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given. The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.