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Aurawamon Sriyuktasuth, D.S.N.*, Piyatida Chuengsaman, M.D.**, Worapan Kusakunniran, Ph.D.***,
Assadarat Khurat, Ph.D.***, Nattaya Rattana-umpa, Ph.D.*
*Faculty of Nursing, Mahidol University, Bangkok 10700, ailand, **Banphaeo Dialysis Group, Bangkok, ailand, ***Faculty of Information and
Communication Technology, Mahidol University, Nakhon Pathom 73170, ailand.
Telehealth Service for Patients Receiving Continuous
Ambulatory Peritoneal Dialysis: A Pilot Study
ABSTRACT
Objective: is study aimed to assess the feasibility and acceptability of delivering a telehealth intervention, called
PD Telehealth, for improving health outcomes among ai patients receiving continuous ambulatory peritoneal
dialysis (CAPD).
Materials and Methods: is pilot study enrolled 104 patients receiving CAPD, who were randomly classied into
two groups: PD Telehealth group (PD Telehealth service plus usual care; n = 52) and usual care group (usual care
only; n = 52). e 6-month telehealth service was provided to participants to deliver self-management support
and telemonitoring while they received home-based treatment. Further, the repeated measures mixed analysis of
variance test was used to assess health outcomes at baseline, 3months, and 6months. Additionally, feasibility and
acceptability were assessed.
Results: Notably, the measured baseline characteristics of the two groups were not dierent. Regarding quality of life, a
signicant interaction eect was observedon two domains of the 36-Item Short Form Survey-general health (p = 0.002) and
reported health transition (p = 0.018). However, self-management and clinical outcomes did not dier signicantly between
the two groups over 6 months. e PD Telehealth group demonstrated high acceptability and feasibility of the application.
Conclusion: e PD Telehealth service has been demonstrated to be feasible and acceptable for providing care to
patients receiving CAPD. However, there were no signicant dierences in the main outcomes of the study. Further
research studies involving a larger and more diverse sample population and conducted over a longer period are
needed.
Keywords: PD Telehealth; peritoneal dialysis; telehealth (Siriraj Med J 2023; 75: 46-54)
Corresponding author: Aurawamon Sriyuktasuth
E-mail: aurawamon.sri@mahidol.ac.th
Received 22 September 2022 Revised 9 December 2022 Accepted 11 December 2022
ORCID ID:http://orcid.org/0000-0002-6899-5927
http://dx.doi.org/ 10.33192/smj.v75i1.260529
All material is licensed under terms of
the Creative Commons Attribution 4.0
International (CC-BY-NC-ND 4.0)
license unless otherwise stated.
INTRODUCTION
In 2008, the ai government implemented the PD
First policy to increase the access to dialysis treatment
among ai citizens. Under universal health coverage,
people can access dialysis treatment for free in the form of
continuous ambulatory peritoneal dialysis (CAPD) as the
rst dialysis modality unless contraindicated.1 Notably,
CAPD has fewer technical requirements and lesser need
for medical sta,2 and it is more cost-eective.3 erefore,
the number of patients receiving CAPD in ailand has
increased. According to the ai Renal Replacement
erapy registry, the number of patients receiving PD
has increased from 5,133 in 2009 to 34,467 in 2020.4 Of
all patients receiving PD in ailand, 97% were receiving
CAPD, and only 3% were receiving automated PD.1
e challenges associated with CAPD care include
complication management and prevention, technique
failure intervention, long-term CAPD sustenance, and
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quality of life (QOL) improvement. However, currently
available healthcare services for CAPD do not support
patients and their families to eectively and safely perform
dialysis at home. us, a well-designed healthcare service
is required to support home-based treatment and provide
eective care to this population.
Telehealth was developed to promote PD regimen
adherence and ensure continuous safety and eectiveness.5,6
Although evidence suggests improved patient outcomes
by telehealth programs among those receiving PD,7-9 in
ailand, there is a lack of tailored telehealth to support
patients receiving CAPD. erefore, PD Telehealth was
developed for ai patients receiving CAPD as well
as caregivers and healthcare professionals to provide
self-management support, monitor home dialysis, and
enhance patient health and professional communication
as required by all key stakeholders.10 PD Telehealth
aimed to transform its current care delivery model,
support home-based treatment, and improve health
outcomes in patients receiving CAPD. is study reports
the results of a pilot study designed to assess the eects
of PD Telehealth on self-management behaviors, QOL,
and clinical outcomes and to evaluate the feasibility and
acceptability of PD Telehealth in ai contexts.
MATERIALS AND METHODS
Study design and participants
is two parallel-group randomized controlled pilot
study was conducted at Banphaeo Dialysis Center, Bangkok,
ailand (ai Clinical Trials Registry identication
number: TCTR20221121004). Eligibility criteria were as
follows: patients aged >18 years, those who had received
CAPD for at least 3 months and were actively undergoing
dialysis procedures, those who had no prior peritonitis
in the last 3 months, and those using a smartphone or
tablet with an android operating system of ≥version 6
and internet access. Patients who were bedridden or
had cognitive impairment, psychiatric illness, or serious
illness/condition were excluded from the study. Notably,
participants who discontinued CAPD treatment or were
referred to other PD clinics were withdrawn from the
study sample. The sample size was calculated using
power analysis. e required sample size calculation for
repeated measures mixed analysis of variance (ANOVA)
test indicated a sample of 104 participants (52 per group),
with a power (p) of 0.80, signicance level (α) of 0.05,
medium eect size (f) of 0.25,11 and attrition rate of 20%.
e study objectives, protocol, benets, risks, privacy,
and condentiality were explained to all eligible participants.
e participants were then randomly assigned to group
receiving PD Telehealth plus usual care or that receiving
usual care alone over 6months aer obtaining their
informed consent and preforming the baseline assessment
(Fig 1). ey were evaluated using a questionnaire at 3
and 6months, and their health information was obtained
from medical records.
Fig 1. Flow diagram of participant eligibility and randomization process
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Intervention
PD Telehealth is a service operated through a
mobile application (patient side) and a web application
(dialysis center side) called PD Easy. It was developed
by a multidisciplinary team based on a user-centered
approach. Both applications comprise multiple features
to serve the needs of patients, caregivers, and healthcare
professionals.10 ese features were linked using the
central database and processing unit at the server.
e patient-side mobile application included eight
core functions: (a) daily health and dialysis records,
(b) information, (c) health advice, (d) reminders, (e)
health alerts, (f) social forum, (g) news and knowledge
management, and (h) contacts (Fig 2.1). e participants
in the intervention group installed the application on
their smartphone or tablet and were trained about its use.
ey were instructed to send the daily dialysis records and
health-related information to the dialysis center. ey were
notied when the recorded data exceeded the set value.
ey could review PD-related resources using video clips
and text-based materials. In addition, they were informed
about follow-up and treatment appointments at the clinic
through personal health alerts and reminders. e social
forum allowed participants to share and learn from each
other. Participants’ contacts were used to remotely connect
with healthcare providers, which potentially reduced
patient visits to the clinic; moreover, participants could
upload photos of, for example, exit site and dialysis uid
and contact healthcare providers for advice via the chat
box. However, participants were informed that the data
they sent would be checked regularly but not in real time.
ey had to call the healthcare providers for urgent or
immediate medical assistance because PD Telehealth
was not designed to support emergency services.
A web application was used to manage the PD Telehealth
service at the dialysis center (Fig 2.2). Healthcare providers
monitored patients by reviewing their health records
through a secure password-protected web application.
e clinic’s health team, including a PD nurse, a dietician,
and two public health technical ocers, regularly reviewed
alerts based on their assigned responsibilities. e team
was notied via the web application when participants
entered the alert zone, and the team coordinated with
other healthcare providers as needed to provide care.
Appropriate contacts and follow-up were established
through the application, telephone call, and home or
clinic visit as required.
Outcome measurement
e study outcomes included self-management (using
the PD Self-Management Scale [PDSMS]),12 QOL (using
the Choice Health Experience Questionnaire [CHEQ]
ai version),13 and clinical outcomes (obtained from
patient’s medical records). Furthermore, the feasibility
and acceptability of PD Telehealth services among ai
patients receiving CAPD were evaluated. Notably, the
feasibility was determined by application usage (obtained
from Google Analytics) and retention rates, and the
acceptability was assessed using the Perceived Benets
of the PD Telehealth Questionnaire developed by the
research team.
Log in page Main menu Main board Individual health and dialysis
Fig 2. Sample screenshots of PD Telehealth
2.1 e mobile application 2.2 e web application
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Statistical analysis
All statistical analyses were performed using the
Statistical Package for the Social Sciences (SPSS Inc.,
Chicago, IL). Descriptive statistical analysis was used
to summarize patient characteristics, feasibility, and
acceptability. e chi-square, Fisher’s exact, or independent
t test was used to compare baseline characteristics between
the two groups. Repeated measures mixed ANOVA test
was used to compare self-management, QOL, and clinical
outcomes between the two groups at baseline, 3months,
and 6months. Furthermore, intention-to-treat analysis
was used for study analysis.
RESULTS
Patient characteristics
Overall, 104 participants completed the pretest. Of
these, 3 and 9 from the intervention and control groups
withdrew from the study, respectively. In contrast, 92
participants completed the post-test at the end of the study
(49 and 43 from the experimental and control groups,
respectively). Furthermore, there was no difference
between the two groups at baseline (Table 1).
Self-management
Self-management was assessed using PDSMS, and
there was no dierence in self-management in the overall
scores or each of the ve domains between the two groups
at any time point (Table 2).
QOL
In this study, the QOL was determined using the
CHEQ ai version, which included the general health
36-Item Short Form Survey (SF-36) and end-stage kidney
disease (ESKD)-specic domains. Notably, there was a
signicant interaction eect between groups and time on
two domains of the 36-Item Short Form Survey—general
health (p = 0.002) and reported health transition (p =
0.018). ere was no signicant dierence between the
two groups in the ESKD domains throughout the study
period (Table 3).
Clinical outcomes
Clinical outcomes (i.e., hematocrit, albumin, and
phosphate levels) were measured at baseline, 3months,
and 6months. ere was no signicant dierence at
any time point in this study (Table 4). Additionally,
no signicant dierence in other clinical outcomes,
including overhydration (OH) value and peritonitis, exit
site infection, and mortality rates, was found between
the two groups.
Feasibility of PD Telehealth
Overall, 52 participants received the intervention
(PD Telehealth); of these, 49 (94.2%) completed the study,
and 3 (5.8%) did not complete the planned follow-up
because of death. Notably, PD Telehealth adherence was
high. In the intervention group, 70.2% participants used
TABLE 1. Participant characteristics at baseline (n = 104).
Characteristics Experimental group Control group P value
(n = 52) (n = 52)
n (%) or mean ± SD n (%) or mean ± SD
Age (years) 52.8 ± 13.9 51.7 ± 11.5 0.524c
Gender (male) 31 (59.6) 29 (55.8) 0.691a
Marital status (married) 30 (57.7) 29 (55.8) 0.749a
Income (<15,000/month) 36 (69.2) 28 (53.8) 0.362b
Education (primary school) 24 (46.2) 19 (36.5) 0.714a
Employment status (unemployed) 30 (57.7) 26 (50.0) 0.241a
Healthcare scheme (universal coverage) 44 (84.6) 43 (82.7) 0.798b
Duration of dialysis (months) 32.5 ± 23.7 35.4 ± 25.6 0.362c
aChi-square test. bFisher’s exact test. cIndependent t test.
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TABLE 2. Self-management at baseline, 3 months, and 6 months between the two groups.
Self-management Intervention Control Repeated measures*
n Mean ± SD n Mean ± SD Within Between Interaction
times, p groups, p effect, p
Overall scoreb Baseline 52 80.9 ± 10.3 52 83.0 ± 8.3 0.765 0.795 0.772
3 months 50 81.5 ± 9.0 51 82.8 ± 9.5
6 months 49 80.8 ± 8.9 43 81.2 ± 10.2
Dialysisa Baseline 52 36.0 ± 4.1 52 36.8 ± 3.6 0.616 0.621 0.455
3 months 50 36.5 ± 3.7 51 36.6 ± 4.1
6 months 49 36.3 ± 3.7 43 36.1 ± 4.5
Diet and uid Baseline 52 12.4 ± 2.4 52 12.1 ± 2.6 0.800 0.961 0.122
intakea 3 months 50 12.1 ± 2.3 51 12.5 ± 2.5
6 months 49 12.3 ± 2.0 43 11.9 ± 2.4
Medicationb Baseline 52 10.1 ± 2.4 52 10.8 ± 1.5 0.837 0.794 0.820
3 months 50 10.5 ± 1.4 51 10.6 ± 1.5
6 months 49 10.1 ± 2.1 43 10.7 ± 1.5
Self-assessmenta Baseline 52 13.0 ± 2.1 52 12.8 ± 2.1 0.357 0.866 0.102
3 months 50 12.5 ± 2.4 51 13.1 ± 2.0
6 months 49 12.7 ± 2.4 43 12.5 ± 1.9
Complication Baseline 52 9.3 ± 2.2 52 9.6 ± 2.2 0.463 0.709 0.903
managementa 3 months 50 9.9 ± 2.0 51 9.8 ± 2.0
6 months 49 9.6 ± 2.1 43 9.7 ± 1.7
aSphericity assumed. bWithin-group eects by Greenhouse–Geisser test.
the application more than thrice a week, 55.3% used it
daily to report dialysis and health-related information,
and 4.3% used it once a month. Over a 6-month period,
the top three most frequently used features were personal
health and dialysis records (5,788 times), social forums
(1,092 times), and personal health alerts (814 times).
PD Telehealth acceptability
At the end of the study, the PD Telehealth group
rated the mobile application as useful (8.73±1.70). e
top three advantages were health problem management
(8.71±1.59), health information provision (8.67±1.77),
and home healthcare support (8.59±1.80; Table 5).
DISCUSSION
To the best of our knowledge, this is the rst pilot
study in ailand to develop a telehealth service for
CAPD. e ecacy of PD Telehealth demonstrated fewer
opportunities to improve the measured outcomes. In this
study, participants’ self-management scores were good
at baseline and throughout all follow-up periods. Based
on the inclusion criteria, all participants were required
to actively perform CAPD themselves, indicating that
they were able to manage their own care. erefore, the
mobile application in CAPD care in this study did not
contribute to changes in self-management.
In terms of QOL, the results showed that the SF-
36 general health and reported health transition scores
improved in the PD Telehealth group aer 3 and 6months,
respectively, whereas these scores declined in the control
group. Notably, our study results are consistent with
previous systematic reviews by Cartwright et al.,8 Yang
et al.,6 and Lunney et al.,5 which reported that some domains
of QOL were signicantly improved in patients receiving
PD and chronic dialysis aer telehealth interventions. Our
telehealth service provided remote monitoring, supported
home-based treatment, and fullled the healthcare needs
of such patients. However, the eects were small; therefore,
its eects on QOL should be investigated further in ai
patients receiving CAPD.
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TABLE 3. Quality of life at baseline, 3 months, and 6 months between the two groups.
Treatment time Repeated measures
QOL Group Baseline 3 months 6 months Within Between Interaction
times, p groups, p effect, p
SF-36
PFa Intervention 51.9 ± 24.6 56.4 ± 24.1 59.1 ± 23.9 0.479 0.847 0.234
Control 57.9 ± 28.1 52.2 ± 28.9 57.9 ± 23.8
RPa Intervention 48.1 ± 41.1 57.0 ± 41.7 47.4 ± 44.0 0.694 0.353 0.168
Control 46.1 ± 43.0 41.7 ± 41.7 45.3 ± 43.7
BPa Intervention 67.3 ± 23.9 69.6 ± 23.3 68.3 ± 22.7 0.637 0.322 0.842
Control 65.5 ± 25.2 65.6 ± 28.3 63.3 ± 25.6
MHa Intervention 63.8 ± 10.7 63.6 ± 11.1 62.9 ± 9.4 0.254 0.612 0.857
Control 69.0 ± 17.3 66.0 ± 15.7 67.0 ± 16.8
REa Intervention 61.1 ± 42.4 66.5 ± 43.6 57.1 ± 46.5 0.326 0.383 0.057
Control 63.5 ± 41.5 48.5 ± 44.5 53.5 ± 44.5
SFa Intervention 80.0 ± 18.1 77.5 ± 19.8 79.3 ± 23.0 0.890 0.704 0.768
Control 78.4 ± 22.6 79.0 ± 20.3 77.6 ± 19.6
VTa Intervention 59.7 ± 14.8 59.7 ± 10.7 60.8 ± 11.2 0.764 0.235 0.865
Control 58.2 ± 18.8 58.2 ± 18.8 58.2 ± 16.9
GHa Intervention 54.1 ± 18.8 46.6 ± 18.4 50.8 ± 14.1 0.336 0.149 0.002
Control 49.1 ± 25.1 47.1 ± 21.4 45.3 ± 20.7
HTa Intervention 69.7 ± 25.4 65.3 ± 25.9 74.0 ± 22.8 0.882 0.764 0.018
Control 67.8 ± 22.9 70.0 ± 26.2 65.7 ± 25.6
ESKD
CRPa Intervention 78.8 ± 25.9 74.5 ± 26.5 75.5 ± 24.2 0.463 0.240 0.791
Control 84.6 ± 19.9 82.8 ± 26.4 80.2 ± 22.2
CMHa Intervention 74.8 ± 19.3 74.0 ± 15.3 72.6 ± 17.8 0.509 0.421 0.396
Control 71.6 ± 20.6 74.6 ± 20.1 72.6 ± 17.2
CGHa Intervention 59.2 ± 31.7 59.6 ± 28.1 63.3 ± 24.3 0.900 0.861 0.579
Control 66.9 ± 34.0 63.5 ± 33.8 60.9 ± 33.5
FREb Intervention 55.6 ± 26.5 54.6 ± 29.9 58.8 ± 23.9 0.497 0.391 0.755
Control 62.3 ± 24.0 64.6 ± 29.8 62.3 ± 25.4
TRVa Intervention 73.6 ± 25.9 71.8 ± 30.2 70.4 ± 26.4 0.453 0.747 0.280
Control 74.5 ± 29.5 79.7 ± 23.4 73.2 ± 26.1
CFa Intervention 64.5 ± 19.7 65.8 ± 24.0 66.3 ± 21.5 0.481 0.785 0.692
Control 67.9 ± 20.1 68.3 ± 21.8 65.7 ± 18.5
FINa Intervention 75.0 ± 27.6 72.9 ± 28.6 71.9 ± 27.3 0.654 0.774 0.961
Control 75.0 ± 27.6 76.0 ± 26.8 74.4 ± 31.6
DRa Intervention 61.1 ± 24.5 60.4 ± 26.7 61.7 ± 25.6 0.332 0.439 0.254
Control 64.4 ± 31.4 62.5 ± 30.5 69.8 ± 24.1
RECa Intervention 65.4 ± 23.8 67.7 ± 25.8 64.6 ± 25.2 0.534 0.989 0.634
Control 71.6 ± 32.5 66.1 ± 28.9 66.3 ± 25.5
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TABLE 3. Quality of life at baseline, 3 months, and 6 months between the two groups. (Continued)
Treatment time Repeated measures
QOL Group Baseline 3 months 6 months Within Between Interaction
times, p groups, p effect, p
ESKD
WRKa Intervention 58.6 ± 38.9 55.2 ± 38.9 58.2 ± 37.6 0.264 0.018 0.627
Control 78.8 ± 29.4 68.7 ± 37.0 66.3 ± 35.3
BIb Intervention 81.7 ± 21.6 84.0 ± 21.9 80.7 ± 23.8 0.518 0.028 0.980
Control 88.5 ± 20.7 90.5 ± 16.7 88.4 ± 17.5
SYMa Intervention 20.3 ± 12.1 20.1 ± 13.2 18.9 ± 11.3 0.631 0.100 0.951
Control 23.0 ± 14.3 21.5 ± 14.5 23.2 ± 13.3
SEXb Intervention 79.6 ± 29.8 80.2 ± 27.1 74.0 ± 28.3 <0.001 0.613 0.125
Control 85.1 ± 25.0 76.8 ± 31.9 77.2 ± 26.1
SLPa Intervention 46.7 ± 16.3 46.9 ± 16.5 48.3 ± 16.4 0.482 0.366 0.307
Control 44.1 ± 18.1 48.4 ± 21.5 49.5 ± 20.8
DACa Intervention 80.2 ± 16.5 83.6 ± 16.0 78.7 ± 22.7 0.002 0.204 0.594
Control 85.9 ± 19.1 88.0 ± 16.7 80.6 ± 20.6
QOLa Intervention 66.9 ± 19.9 64.6 ± 19.5 66.1 ± 18.9 0.101 0.588 0.733
Control 64.6 ± 21.4 60.8 ± 16.4 62.9 ± 18.9
Abbreviations: BI, body image; BP, bodily pain; CF, cognitive function; CGH, CHEQ general health; CMH, CHEQ mental health; CRP,
CHEQ role physical; DAC, dialysis access-related problems; DR, dietary restrictions; FIN, nances; FRE, freedom; GH, general health; HT,
reported health transition; MH, mental health; PF, physical functioning; QOL, quality of life; RE, role emotional; REC, recreation; RP, role
physical; SEX, sexual functioning; SF, social functioning; SLP, sleep; SYM, symptoms; TRV, travel restrictions; VT, vitality; WRK, work.
aSphericity assumed. bWithin-group eects by Greenhouse–Geisser test.
TABLE 4. Clinical outcomes at baseline, 3 months, and 6 months between the two groups
Items Group Treatment time Repeated measures
Baseline 3 months 6 months Within Between Interaction
times, p groups, p effect, p
Hematocritb Intervention 30.2 ± 6.2 30.1 ± 6.0 29.7 ± 6.3 0.320 0.681 0.386
Control 31.3 ± 6.3 29.5 ± 6.6 30.6 ± 6.7
Albumina Intervention 3.3 ± 0.5 3.4 ± 0.6 3.3 ± 0.5 0.791 0.809 0.051
Control 3.3 ± 0.6 3.2 ± 0.6 3.3 ± 0.6
Phosphateb Intervention 4.3 ± 1.6 4.6 ± 1.6 4.5 ± 1.5 0.915 0.963 0.080
Control 4.8 ± 2.0 4.5 ± 1.6 4.7 ± 1.7
aSphericity assumed.
bWithin-group eects by Greenhouse–Geisser test.
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TABLE 5. Perceived benets of the PD Telehealth service (n = 49).
PD Telehealth usefulness n Possible range Actual range Mean SD
Overall 49 0–10 2–10 8.73 1.70
Managing health problems more appropriately 49 0–10 2–10 8.71 1.59
Receiving useful health information 49 0–10 2–10 8.67 1.77
Taking care own health more appropriately 49 0–10 2–10 8.59 1.80
Motivating to take care of oneself 49 0–10 2–10 8.53 1.73
More access to health information 49 0–10 2–10 8.49 1.82
Enhancing learning 48 0–10 2–10 8.42 1.92
Reducing anxiety related to health 49 0–10 2–10 8.39 1.80
More access to healthcare services 49 0–10 2–10 8.35 1.95
Being assessed and monitored 49 0–10 2–10 8.31 1.88
Receiving more healthcare 49 0–10 2–10 8.20 1.87
Clinical results revealed no statistically signicant
changes in laboratory measures. Moreover, no statistically
signicant dierences were found between the two groups,
although the control group had a higher number of
participants who had peritonitis and died during the
study. ese results were consistent with the ndings of a
systematic review on the impact of telehealth interventions
in patients with ESKD, including PD and HD.5 More
eective strategies and a longer period may be required
to determine clinical outcome changes caused by the PD
Telehealth service.
The intervention group’s application use and
retention rates were accepted in terms of feasibility and
acceptability. Only two participants, who rarely used
the mobile application, rated its benets as minor. PD
Telehealth development was focused on those with low
computer skill levels and vision problems because most
patients receiving CAPD under universal coverage in
ailand are in their middle and late adulthood. Hence,
most participants, particularly the older adults, reported
no diculties in using the application. e results of this
study demonstrated that this platform is acceptable for
patients receiving CAPD. All available functions were
used, with high-level benets reported. e main features
of PD Telehealth were designed to meet the needs of key
stakeholders to solve their problems related to health
service.10 erefore, PD Telehealth can be used in ai
contexts. Some ndings of this study are consistent
with those reported in pilot studies, which revealed that
telehealth programs are a viable solution for monitoring
and optimizing the care of patients receiving PD.14,15
Our results underscore the potential of telehealth
services for the delivery of CAPD care in ailand. is
platform is intended for use by healthcare providers in PD
centers and eventually as part of their routine practice.
e service can be used to engage patients with CAPD
in their own care, as proposed by the World Kidney
Day Steering Committee.16 However, more research is
needed to demonstrate the ability of PD Telehealth to
improve patient outcomes and the quality of healthcare. A
larger longer-term controlled study is needed to conrm
the eectiveness of PD Telehealth in patients receiving
CAPD.
is study has some limitations. e sample size
was small and the study duration was short; thus, the
dierences in health outcomes could not be observed.
Furthermore, this study was limited by its single-center
nature and sample population size as the participants
were recruited from only one dialysis center in Bangkok,
ailand.
ACKNOWLEDGMENTS
is work was funded by the Health Systems Research
Institute, ailand. We would like to thank all the patients
and healthcare providers who were involved in this
study.
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54
Ethics Statement: e present study was approved by the
Institution Review Broad, Faculty of Nursing Mahidol
University (COA: No. IRB-NS2018/455.1307).
Conict of interest: All authors declare that they have
no personal or professional conict of interest.
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