The Chronic Kidney Disease HIT has published its proof of concept study for tele-clinics for kidney transplant patients in BMJ Open. The study found that the tele-clinics were well received by patients, increased attendance rates, saved money and made significant savings in CO2 emissions.
The paper describes the project, which used a Quality Improvement approach with iterative Plan–Do–Study–Act (PDSA) cycles to test the introduction of a tele-clinic service. The service was co-designed with patients and developed a prototype delivery model that was tested iteratively.
Nineteen tele-clinics were held involving 168 kidney transplant patients (202 tele-consultations). With the tele-clinic, 2.9 per cent of patients did not attend compared with 6.9 per cent for face-to-face appointments.
Improving both blood test quality and availability for the tele-clinic was a major focus. Blood tests were provided by GPs, with labs sending results to both the hospital and GP surgery. Blood test quality for tele-clinics improved from 25 per cent to 90.9 per cent.
Patient satisfaction was high: 97.9 per cent of survey respondents were satisfied overall with their tele-clinic, and 96.9 per cent of the patients would recommend it to other patients. The tele-clinic saved 3,527 miles of motorised travel in total, equating to a saving of 1,035 kgCO2.
There were no unplanned admissions within 30 days of the tele-clinic appointment. The service provided an immediate saving of £6,060 for commissioners due to reduced tele-clinic tariff negotiated locally (£30 less than face-to-face tariff).
The project has shown that tele-clinics for kidney transplant patients are deliverable and well received by patients with a positive environmental impact and modest financial savings. It has the potential to be rolled out to other renal centres if a national tele-clinic tariff can be negotiated, and an integrated, appropriately reimbursed community phlebotomy system can be developed to facilitate remote monitoring of patients.
Establishing a tele-clinic service for kidney transplant recipients through a patient-codesigned quality improvement project
Udaya Prabhakar Udayaraj, Oliver Watson, Yoav Ben-Shlomo, Maria Langdon, Karen Anderson, Albert Power, Christopher Dudley, David Evans, Anna Burhouse
Published in BMJ Open