Three-year telemedicine trial evaluates home dialysis in Alabama
January 21, 2015
A three-year telemedicine trial being run by UAB Medicine’s Red Mountain home dialysis training unit in Alabama, USA, will allow its peritoneal dialysis (PD) patients living outside Jefferson County to eliminate some of their trips to Birmingham for monthly check-ups.
Funded by a US$180,000 grant from Baxter International, the trial seeks to determine if this arrangement produces greater quality of life for PD patients without compromising outcomes.
Unlike the multiple weekly clinic treatments involved in traditional hemodialysis, PD patients enjoy the relative freedom of nightly home therapy, so the use of telemedicine for the required monthly physician evaluation promises to ease the burden of managing their kidney disease.
“Some of our patients drive several hours to see us once a month,” said Eric Wallace, an assistant professor in the division of nephrology and director of the UAB peritoneal dialysis programme, which is conducting the study. “We’re targeting patients who are already part of our PD programme and live the furthest away, including some as far south as Dothan and as far north as Florence.”
Roughly 40 Red Mountain patients will participate in the telemedicine trial for each of its three years. They will complete six monthly face-to-face visits and another six months of telemedicine evaluations for comparison.
Only two other home dialysis programmes in the USA are using telemedicine in any capacity, mainly in addition to office appointments. UAB’s trial is more ambitious, as it seeks to eliminate some of those visits, and it doesn’t require patients to furnish their own equipment, so those with limited means aren’t excluded.
“This will put us up there with the most progressive home dialysis programmes in the world,” Wallace said. “We expect to have some sites up and running by July of 2015.”
In Alabama, neither private insurance nor Medicare or Medicaid covers telemedicine for PD, or home dialysis as it’s commonly known. So the grant from Baxter International will fund the cost of UAB doctors, a research coordinator to conduct the study’s quality of life surveys, nursing support at the county health departments, and videoconferencing terminals at UAB’s end. The Alabama Department of Public Health is pursuing telemedicine initiatives of its own, so it is covering the expense of technology at its local health departments, including Bluetooth-equipped stethoscopes that will transmit sound in real time to physicians on the other end of the videoconference.
The results of the trial could influence whether telemedicine for PD becomes sanctioned by Medicare in Alabama, and, ultimately, by private insurers. Some 28 other states, including Mississippi and Georgia, already mandate private insurance coverage for telemedicine in many health care specialties.
“Alabama is not one of those 28 states, so virtually no telemedicine occurs in Alabama unless it’s for Medicare patients,” Wallace said. “Medicare is fairly progressive about covering telemedicine, but before it is implemented across the board in a meaningful way, private insurers have to buy in. This trial is a first step in that process.”
In Alabama, telemedicine is being used in certain clinical capacities covered by Medicare, including psychiatry, HIV and AIDS outreach, and ophthalmology. As telemedicine becomes more widely accepted, it could open additional doors for UAB to export highly sub-specialised care to communities that need it. Within the field of nephrology, rural providers may lack the expertise to manage complex conditions such as polycystic kidney disease and Fabry disease, for example. The more conveniently UAB can deliver care, the more likely patients are to pursue advanced treatment and stick with it.
“It’s not always medically necessary for me to see them in person,” Wallace said. “This is potentially a way to export our super-subspecialties to the rest of Alabama and really make a difference. I’m hoping that others will piggyback off this and start recognising the benefits of telemedicine, particularly for patients in remote areas.”