Implementation and evaluation of a smartphone-based application for continuous ambulatory peritoneal dialysis (CAPD) patients: a prospective feasibility cohort study and collaborative effort of patients and the peritoneal dialysis team.

Background: eHealth technology bridging home and hospital care was shown to allow efficient use of healthcare resources in automated peritoneal dialysis (APD). Data on eHealth applications in patients on continuous ambulatory PD (CAPD) are scarce. We evaluated implementation of a smartphone app enabling remote patient care in CAPD. Methods: In this prospective observational cohort study, all PD patients were informed and could choose whether or not to use the app. A confounder-controlled analysis was performed to compare outcomes between users and non-users. App users rated experienced support, feeling of safety and need for interim hospital visits. Renal nurses participated in a structured interview. Results: A total of 36 of 72 participating patients used the app. The app was associated with a 90% decrease in hospital admission days [95% confidence interval (CI) 51-98] and a 62% decrease in hospital admissions (95% CI 21-83). There was no clear effect on the number of emergency room visits, consultations and patient-reported outcomes. Patient's satisfaction with the app was high (mean rating 4.8 on a 1-5 scale), experiencing a decrease in the need for hospital visits and almost all felt safer. Nurses appreciated a time-efficient improvement in quality of patient-focused care. Conclusion: Implementation of the app maintained and even increased interaction between patients and the PD team time-efficiently. The app was associated with fewer hospitalization days and was rated positively by patients and nurses. The safe sharing of photos feature reduced interim hospital visits, presumably lowering the carbon footprint. We embedded the app in our practice as a form of value-based healthcare.