title: Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD.
abstract: Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters.
  
  
  
  We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures.
  
  
  
  In total, 47 patients (26 men; mean age =59 years old; 33% were ≥65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (>80% performed ≥80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged.
  
  
  
  Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial.
authors.affiliation: Departments of Pharmacy.|Nephrology.
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Ong
authors.affiliation: Medicine.|Nephrology.|Institute of Health Policy, Management and Evaluation.|Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sarbjit V
authors.initials: SV
authors.lastname: Jassal
authors.affiliation: Medicine.|Nephrology.|Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Miller
authors.affiliation: Nursing, and.|Nephrology.
authors.forename: Eveline C
authors.initials: EC
authors.lastname: Porter
authors.affiliation: Techna Institute, University Health Network, Toronto, Ontario, Canada.|Lunenfeld-Tanenbaum Research Institute and Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation.|Institute of Biomaterials and Biomedical Engineering.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Cafazzo
authors.affiliation: Centre for Global eHealth Innovation, and.|Techna Institute, University Health Network, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation.
authors.forename: Emily
authors.initials: E
authors.lastname: Seto
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, and.|Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Thorpe
authors.affiliation: Medicine.|Nephrology.|Lunenfeld-Tanenbaum Research Institute and Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.|Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Logan
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D063731:Mobile Applications; D000075082:Proof of Concept Study; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D000068997:Smartphone; D063189:Symptom Assessment
keywords: Humans; Renal Insufficiency, Chronic; Self Care; ambulatory care; blood pressure; chronic kidney disease; hypertension; self-management; smartphone; telemedicine