Results of a pilot feasibility randomised controlled trial exploring the use of an electronic patient-reported outcome measure in the management of UK patients with advanced chronic kidney disease
Paul Cockwell,
Derek Kyte,
Melanie Calvert,
Louise J Jackson,
Gary Price,
Natalie J Ives,
Jon Bishop,
Mary Dutton,
Elizabeth Brettell,
Helen Eddington,
Gabby Hadley,
Stephanie Stringer,
Rav Verdi,
Judi Waters,
Keeley Sharpe,
Nicola Anderson,
Andrew Bissell,
Marie Chadburn,
Elliot Forster,
Sonia O'Brien,
Adrian Wilcockson
Affiliations
Paul Cockwell
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Derek Kyte
3 School of Allied Health and Community, University of Worcester, Worcester, UK
Melanie Calvert
Health Data Research UK (HDR UK) Midlands, Birmingham, UK
Louise J Jackson
3 Health Economics Unit, University of Birmingham, Birmingham, UK
Gary Price
Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Natalie J Ives
Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Jon Bishop
Medical Statistician, NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
Mary Dutton
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Elizabeth Brettell
Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, West Midlands, UK
Helen Eddington
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Gabby Hadley
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Stephanie Stringer
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Rav Verdi
Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Judi Waters
Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Keeley Sharpe
Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Nicola Anderson
Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Andrew Bissell
Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Marie Chadburn
Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Elliot Forster
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Sonia O'Brien
Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Adrian Wilcockson
Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Objectives The use of routine remote follow-up of patients with chronic kidney disease (CKD) is increasing exponentially. It has been suggested that online electronic patient-reported outcome measures (ePROMs) could be used in parallel, to facilitate real-time symptom monitoring aimed at improving outcomes. We tested the feasibility of this approach in a pilot trial of ePROM symptom monitoring versus usual care in patients with advanced CKD not on dialysis.Design A 12-month, parallel, pilot randomised controlled trial (RCT) and qualitative substudy.Setting and participants Queen Elizabeth Hospital Birmingham, UK. Adult patients with advanced CKD (estimated glomerular filtration rate ≥6 and ≤15 mL/min/1.73 m2, or a projected risk of progression to kidney failure within 2 years ≥20%).Intervention Monthly online ePROM symptom reporting, including automated feedback of tailored self-management advice and triggered clinical notifications in the advent of severe symptoms. Real-time ePROM data were made available to the clinical team via the electronic medical record.Outcomes Feasibility (recruitment and retention rates, and acceptability/adherence to the ePROM intervention). Health-related quality of life, clinical data (eg, measures of kidney function, kidney failure, hospitalisation, death) and healthcare utilisation.Results 52 patients were randomised (31% of approached). Case report form returns were high (99.5%), as was retention (96%). Overall, 73% of expected ePROM questionnaires were received. Intervention adherence was high beyond 90 days (74%) and 180 days (65%); but dropped beyond 270 days (46%). Qualitative interviews supported proof of concept and intervention acceptability, but highlighted necessary changes aimed at enhancing overall functionality/scalability of the ePROM system.Limitations Small sample size.Conclusions This pilot trial demonstrates that patients are willing to be randomised to a trial assessing ePROM symptom monitoring. The intervention was considered acceptable; though measures to improve longer-term engagement are needed. A full-scale RCT is considered feasible.Trial registration number ISRCTN12669006 and the UK NIHR Portfolio (CPMS ID: 36497).
