Remote Patient Management in Peritoneal Dialysis: Opportunities and Challenges.

Telehealth describes the use of information and communication technologies to deliver healthcare remotely. Given the twin healthcare pressures of demographic change, where increased numbers of people suffer long-term conditions and there is requirement to deliver care ever more cost effectively, there is a considerable need to make the best use of these technologies in the redesign of clinical services. The opportunity for telehealth in peritoneal dialysis (PD) is to strengthen an already enabled population of resilient individuals who undertake their treatment in the community while at the same time providing the opportunity for more people to have their treatment at home. Relevant to this discussion are the challenges that characterize PD. In many parts of the world, uptake is low, technique survival is disappointing, and access to the therapy is impacted by a range of factors such as socioeconomic status, ethnic minority status, and social isolation. There are barriers to learning the technique that may be physical, educational or cognitive, and support by a family member or paid carer may be required. Can remote monitoring impact these factors - and would its widespread use build confidence in patient perceptions that would enable more people to benefit from home dialysis? For that to happen, a clear sighted goal is required for the development of high quality evidence that examines the opportunities and challenges around its use, and understands the needs of all stakeholders. This is key for appropriate and patient-centered implementation that benefits healthcare outcomes, which matter to patients and to those who provide healthcare. This will not happen by accident and must be carefully built into the plan for the roll out and evaluation of these technologies.