Hybrid Telemedicine and In-Person Care for Kidney Transplant Follow-Up: A Qualitative Study

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-02-13 DOI:10.1111/ctr.70106

Suad Esayed, Ellie Kim, Hannah C. Sung, Abdula Al-Seraji, Simeon Adeyemo, Hayden Troutt, Ekamol Tantisattamoa, Antoney Ferrey, Uttam G. Reddy, Fatima T. Malik, Robert R. Redfield III, Hirohito Ichii, Abimereki D. Muzaale, Divyanshu Malhotra, Fawaz Al Ammary

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Abstract

Background

Kidney transplant recipients are immunocompromised and require lifelong follow-up. Recipients face geographic, socioeconomic, and logistical challenges when seeking follow-up that can be alleviated using telemedicine. We aimed to understand patient experiences and preferences regarding telemedicine video visits and highlight insights to advance adopting hybrid telemedicine/in-person transplant care.

Methods

We conducted qualitative in-depth, semi-structured interviews with kidney transplant recipients between November 18, 2022, and January 11, 2023. Participants had follow-up at ≥12 months post-transplant via telemedicine at a tertiary transplant center. Study enrollment continued until data saturation was reached (n = 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis.

Results

Participants median age was 58 years (IQR, 52–72), and 50% were female, 45% were White, 30% were Black, 15% were Asian, 10% were Hispanic/Other persons, and 30% were out-of-state residents. We identified the following seven themes: (1) reducing travel time, (2) minimizing financial burden (decreasing travel-related expenses and lost wages), (3) engaging patients within their comfort space, (4) establishing rapport with patients, (5) limitations of the virtual physical exam, (6) enhancing access to transplant providers (maximizing adherence to follow-up), and (7) lowering risk of communicable diseases.

Conclusions

Integrating telemedicine with in-person visits enhances post-transplant follow-up care. A hybrid model should leverage the strengths of both modalities, ensuring patient access to care and being patient-centered and flexible. Efforts are needed to advance technological tools in physical examination and human connection, and assess patient outcomes. Policymakers and healthcare systems need to incentivize the adoption and expansion of telemedicine in transplant care.

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混合远程医疗与现场护理对肾移植随访的定性研究

肾移植受者免疫功能低下，需要终身随访。接受者在寻求随访时面临地理、社会经济和后勤方面的挑战，这些挑战可以通过远程医疗得到缓解。我们旨在了解患者对远程医疗视频就诊的体验和偏好，并强调推进采用远程医疗/现场移植护理的见解。方法：我们在2022年11月18日至2023年1月11日期间对肾移植受者进行了定性深入、半结构化访谈。参与者在移植后至少12个月通过三级移植中心的远程医疗进行随访。研究入组一直持续到数据饱和（n = 20名参与者），当从额外的访谈中没有出现新的信息时。对转录本进行归纳主题分析。结果参与者的中位年龄为58岁（IQR， 52-72岁），50%为女性，45%为白人，30%为黑人，15%为亚洲人，10%为西班牙裔/其他人群，30%为州外居民。我们确定了以下七个主题：(1)减少旅行时间，(2)最大限度地减少经济负担（减少旅行相关费用和工资损失），(3)让患者在他们的舒适空间内参与，(4)与患者建立关系，(5)虚拟体检的局限性，(6)增加获得移植提供者的机会（最大限度地坚持随访），以及(7)降低传染病的风险。结论将远程医疗与现场就诊相结合，可提高移植后随访护理水平。混合模式应利用两种模式的优势，确保患者获得护理，并以患者为中心和灵活。需要努力推进体检和人际交往方面的技术工具，并评估患者的预后。决策者和卫生保健系统需要鼓励在移植护理中采用和扩大远程医疗。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.