Abstract
The purpose of this mixed-method study was to 1) develop a model of telemedicine and medication management system for peritoneal dialysis patients 2) develop an application for remote assessment of peritoneal dialysis patients using lessons learned from the COVID 19 pandemic and 3) examine the effectiveness of a model of telemedicine for peritoneal dialysis patients. The sample was composed of nephrologists, pharmacists, peritoneal dialysis nurses, and peritoneal dialysis patients and caregivers. Purposive sampling was used to select the participants. The study was composed of 3 phases: phase 1 situation analysis; phase 2 design and development of a model of telemedicine for peritoneal dialysis patients; and phase 3 examines the effectiveness of a model of telemedicine for peritoneal dialysis patients. The research instruments were a semi-structured interview guide and a model of telemedicine for peritoneal dialysis patients, including 1) telemedicine for peritoneal dialysis patients 2) medication management system for peritoneal dialysis patients and 3) application for remote assessment of peritoneal dialysis patients; feasibility of telemedicine in peritoneal dialysis patients' questionnaire; cost record form; satisfaction of multidisciplinary team in peritoneal dialysis patients' questionnaire; and satisfaction of peritoneal patients' and caregivers' questionnaire. All the questionnaires were developed and validated by five experts. The qualitative data was analyzed using content analysis. The quantitative data was analyzed using descriptive statistics including frequency, percentage, median, interquartile rank, Wilcoxon signed-rank test, and Paired t-test. The results of this study revealed that: 1. The results of the situation analysis study showed that 1) patients and their caregivers have difficulty getting to the hospital as scheduled and have a fear of contracting COVID 19 from hospital visits. The problems with the continuity of taking medication for both chronic kidney disease and comorbidities. Furthermore, there is a limit of home visits during COVID 19 situation 2) patients and multidisciplinary teams suggested that during COVID 19, the methods of care in peritoneal dialysis patients, including treatment and home visits, be adjusted by phone and through online platforms such as line application. Providing peritoneal dialysis patients and caregivers with the knowledge they require for health care. Developing a friendly medication management system for peritoneal dialysis patients and caregivers to decrease travel time and the opportunity to contract COVID 19 and 3) giving information about treatment and self-care of peritoneal dialysis patients during a COVID 19 crisis situation through a line application or other that can be downloaded to a mobile phone and used to communicate with the doctor and nurse when abnormal symptoms and problems are discovered immediately. The results from this study indicated that although the cost of medical and nursing care and the time of health care service spent on telemedicine was higher than those of normal service. Patients and caregivers, on the other hand, paid less for travel to the hospital, spent less time getting to the hospital, and waited less time in the hospital than those in regular service. Furthermore, the multidisciplinary team, patients, and caregivers were satisfied with the telemedicine. As a result, the health-care system may apply the findings of this study to other chronic conditions.
