Telemedicine Perspectives of Patients with Non-Dialysis Kidney Disease and Kidney Transplant - A Qualitative Meta-Analysis

Abstract

Rationale & Objective: While the use of telemedicine has increased dramatically across disciplines, patient perspectives on telemedicine related to chronic kidney disease are not well understood. We systematically reviewed qualitative studies on patients with chronic kidney disease to better understand these patients' perspectives related to telemedicine. Study Design: Qualitative Meta–Analysis Setting & Study Populations: Pre–dialysis chronic kidney disease and kidney transplant patients that used telemedicine. Selection Criteria for Studies: English language studies published in the year 2000 and beyond that investigated patient perspectives in a qualitative manner. Works that were not qualitative or did not focus on provider-patient interactive modes of telemedicine were excluded. Data Extraction: 375 papers were pulled from PubMed, Embase, and Academic Science Premier. After filtering, 8 final papers were selected. These papers were critically appraised for quality and were used in the final analysis. Analytical Approach: We developed a codebook to systematically review each of the selected papers through qualitative meta-analysis. Results: Four primary themes were identified (autonomy, logistics, privacy/confidentiality, and trust) with additional subthemes and further subdivisions to signify positive versus negative experiences. The majority of subthemes and subdivisions (n=9) identified were positively attributed by patients compared to negative attributes (n=6). The subtheme most commonly found was avoiding travel to the hospital, which was identified in all 8 papers. There was substantial variability in the number of papers demonstrating the other subthemes and subdivisions. Limitations: Lack of provider perspectives, non-English studies, and studies published before the year 2000. Papers published after the start of data extraction were also not included. Conclusions: Telemedicine should continue to be offered to patients with kidney disease and kidney transplant patients to facilitate access. Additional research should focus on ways to decrease negative factors experienced by some patients such as difficulty with using the technology.