Telemedicine in Advanced Kidney Disease and Kidney Transplant: A Qualitative Meta-Analysis of Studies of Patient Perspectives.

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 as well as those with kidney transplant to better understand these patients' perspectives related to telemedicine. Study Design: Qualitative meta-analysis. Setting & Participants: 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 articles were pulled from PubMed, Embase, and Academic Science Premier. After filtering, 8 final articles were selected. These articles were critically appraised for quality and were used in the final analysis. Analytical Approach: We used a grounded theory approach to develop a codebook to systematically review each of the selected articles through a qualitative meta-analysis of the included literature. Results: Telemedicine was seen by patients to have notable strengths as well as weaknesses. These characteristics can be organized into 4 primary themes (autonomy, logistics, privacy/confidentiality, and trust). Within each primary theme, we identified subthemes. Universally, all articles included the subtheme "fewer trips to the health care facility" as a beneficial factor of telemedicine within the primary theme "logistics." A majority (6 of 8) of the articles included positive patient perspectives on the primary theme "autonomy" in terms of telemedicine promoting the subtheme of "engagement." Patients' views on telemedicine were mixed regarding the primary themes of "privacy/confidentiality" and "trust" related to telemedicine. Limitations: Lack of provider perspectives, non-English studies, and studies published before the year 2000. Articles published after the start of data extraction were also not included. Conclusions: Telemedicine should continue to be offered to patients with chronic 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 using the technology.

Telemedicine is the ability to do medical visits using technology such as telephone and video calls. For this study, we researched the experiences and perspectives of patients with chronic kidney disease or kidney transplant, who often require complex, coordinated care. We found 8 articles on this topic from 6 different countries and analyzed the text of these publications to see if there were any common themes across the articles. We found 4 major themes autonomy, logistics, privacy/confidentiality, and trust. Within each of these themes, there were positive and negative connotations to telemedicine. Overall, we feel that telemedicine should continue to be available for interested patients, and more research should be done to remove barriers to telemedicine.