Telemedicine need not be filtered out of dialysis centers

The COVID-19 pandemic fueled an explosion in the use of telemedicine for patient care. Telemedicine involves the use of video calls, phone consultations and other online communication tools to provide healthcare services remotely. Like many other areas of medicine, patients with kidney failure who receive treatment at dialysis centers began seeing their kidney doctors (i.e., nephrologists) via telemedicine during the pandemic.

In our study published in Kidney Medicine, we set out to explore patients’ opinions about the use of telemedicine with their nephrologists and other clinicians during their in-center hemodialysis. We were particularly interested in determining if and how telemedicine should be incorporated into future hemodialysis care. While patients and nephrologists may have used telemedicine in other healthcare settings, there are unique features to its use at dialysis centers.

Patients receiving hemodialysis are connected to machines for 3-4 hours three times a week to filter out fluids and kidney toxins. Thanks to federal waivers during the COVID-19 pandemic, both in-person and telemedicine visits can now occur while the patient is hooked up to the dialysis machine. Dialysis facility staff are involved in setting up the telemedicine visit with each patient.

We interviewed 32 patients from the Houston area who receive in-center hemodialysis.

Patients first spoke about how they adapted to telemedicine during the COVID-19 pandemic. They felt that telemedicine helped safeguard them and their doctors from the spread of COVID-19 and allowed for the continuation of care.

While patients did not experience many technological issues, they did rely on staff to help with communication during telemedicine visits with their nephrologists, particularly Spanish-speaking patients who needed translation help. One patient thought that telemedicine was like “killing two birds with one stone” because she could receive her dialysis, complete her visit and have prescriptions called in should they be necessary.

Patients also commented on the availability of their physicians. Telemedicine enabled patients to contact their nephrologists for any urgent medical needs, particularly at the height of the pandemic. As one patient remarked, “If you need your doctor right then, you can FaceTime him or call him.” The availability of providers gave patients peace of mind and facilitated doctor-patient relationships.

In some respects, telemedicine strained communication and limited physical examinations. Patients felt physicians were in a hurry to move on to the next patient when using telemedicine compared to in-person when “I can explain my situation to him.” Though patients generally did not feel that the use of telemedicine affected their care given the circumstances of the pandemic, they did lament the lack of ‘hands-on’ examinations.

Dialysis centers unfortunately lack privacy, however. Patients receive their dialysis in large rooms in which their chairs are close to others and are only separated by thin curtains – if at all. In telemedicine appointments, patients felt like they had to speak louder to be heard, leading to concerns over nosy neighbors listening in. As a result, a patient commented, “You really don’t want to talk because if something’s personal, you don’t want everybody to hear it.”

Patients shared a variety of experiences that gave them confidence in telemedicine, too. Patients’ established relationships with their nephrologists helped ease the transition to telemedicine. Convenience to the patient, a common benefit of telehealth in other clinical settings, was not mentioned in the interviews, perhaps because patients must report to the dialysis facility regardless of whether they see their physician in-person or via telemedicine.

Nevertheless, the experiences of these patients suggest that telemedicine has a role in in-center dialysis care moving forward as it enhances the availability of physicians. To successfully implement telemedicine for in-center dialysis, support for the technology and coordinating visits at dialysis facilities are necessary. In-person visits may also need to supplement telemedicine to help build rapport and facilitate physical interactions.

Telemedicine’s role in reducing the spread of illness is key and should be an option during any future outbreaks, especially given the susceptibility to infection among patients receiving hemodialysis.

Support for this study came from the National Institutes of Health.

By Dr. Trenton M. Haltom, assistant professor of medicine – section of health services research, and Dr. Kevin F. Erickson, associate professor of medicine – section of nephrology. Haltom and Erickson are affiliated with the Center for Innovations in Quality, Effectiveness and Safety (IQuESt).