Kidney Essentials: chronic kidney disease

A digital companion to empower people to understand and manage their chronic kidney disease and acute kidney injury

• Equips people to better manage their kidney disease
• Addresses inequalities
• Reduces outpatient appointments
• Streamlines clinic processes

Impact at a glance:

• Used by over 4,000 NHS patients since its launch in September 2022 across Royal Berkshire NHS Foundation Trust, West Yorkshire, Birmingham and Solihull and Guys and St Thomas
• 3 weeks reduction in waiting times for clinics
• 66% reduction in face-to-face follow-ups
• 96% reported increase in CKD knowledge
• Significant reduction in carbon footprint

This programme is available to license to support patients with CKD across the NHS. Contact hello@cognitant.com to find out more.

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The challenge:

In the UK, there are 3.25 million people living with chronic kidney disease (CKD) stages 3-5. An additional 3.9 million people are estimated to be at stage 1-2 of CKD. This is equal to 7.2 million (>10%) of the UK population. These figures are projected to increase significantly over the coming years (3.9m of people with CKD stage 3-5 by 2033), mainly driven by an ageing population and risk factors such as diabetes, hypertension and cardiovascular disease. (1)

30,000 people in the UK are currently on dialysis, with this projected to rise to 143,000 by 2033. Dialysis costs the NHS an estimated £34,000 per patient in 2023.(1)

A summary of the issues:

• Text based information can compound health literacy barriers. Printed leaflets, the current ‘standard of care’ for health information, can be difficult to access and understand, compounding health literacy barriers (2)
• Low health literacy in CKD is associated with worsening kidney function, increased hospitalisation and mortality (versus higher literacy levels) (3).
• Appointments are time-limited and healthcare professionals struggle to communicate all key information, while patients struggle to retain it all during consultation
• Printed information is incompatible with remote models of care

Royal Berkshire NHS Foundation Trust wanted to redesign the delivery of their outpatient service, with greater focus on virtual care, and remote ways of providing accessible and impactful patient education. 

The Trust looked for a solution to support patients with CKD, by presenting engaging and accessible health information to help them understand their diagnosis, staging, and how to look after their renal health.

The ultimate aim was to help patients to better understand and manage their health, thus improving health outcomes (such as avoidable complications and disease progression) and reducing demand on resources. The team also wished to evaluate the use of this avatar-led programme versus the traditional way of educating CKD patients and so a year-long pilot was run. For the pilot, the information was available in two formats: written information with diagrams and our immersive, interactive format with an avatar guide. Both formats were put to the test by the Trust’s patients.

The solution: ‘Kidney Essentials: CKD’

Functionality

• An engaging and accessible health information programme, using avatars, to help patients understand
  • their diagnosis
  • staging
  • how to look after their renal health.
• Supported by a platform – Healthinote – which enables clinicians to create personalised health information prescriptions which can be emailed or texted to a patient
• Viewable via the Healthinote app or via the Healthinote website, with the option of viewing it on any digital device

The resource is designed to be used any time, anywhere, allowing patients to view the information in the comfort of their own home or their place of choice. The resource can be saved and returned to at any time as well as shared with friends, families and carers.

Patients without digital technologies are able to be given the equivalent information in written format with accompanying visuals.

Targets set

Kidney Essentials sets ambitious targets to measure patient outcomes, experience, integration, and efficiency.

• Patient outcomes: Increased knowledge and understanding of CKD and improvements in disease management
• Enhanced patient experience: Ease of understanding and navigation
• Integration through seamless incorporation of the programme into existing healthcare workflows.
• Efficiency and the environment: Reductions in healthcare resource utilisation and consequent environmental gains.

Translation and Cultural Adaptation:

Consultation records indicated that Polish, Nepali, Punjabi and Urdu were highly requested for translation in local Berkshire practices during patient consultations. Cultural adaption of the Kidney Essentials: CKD  included translation into these languages, the inclusion of culturally appropriate avatars and culturally specific changes to the content, such as nutritional advice.

Financial assessment

The financial impact and value for money of Kidney Essentials were assessed by:

• evaluating the costs of triaging new referrals and remote monitoring, which replaced 30% of face-to-face appointments, leading to substantial financial savings and reductions in travel-related emissions.
• evaluating the savings delivered through the above.
• calculating value for money, determined by comparing these savings against the programme’s investment costs.
• Additionally, user feedback was gathered through questionnaires, assessing user experience, ease of use, ease of understanding, and self-reported increases in knowledge, further supporting the programme’s effectiveness and overall value.

Results and testimonials:

Kidney Essentials has met and exceeded performance targets at the Roya Berkshire NHS Foundation Trust.

Financial, operations and environmental impact

• Since its launch in September 2022, Kidney Essentials has supported 3,475 CKD patients across multiple regions.
• These users participated in 4,256 sessions, generating 7,199 page views, with an average session time of 4 minutes 47 seconds.
• The platform has driven significant efficiencies, including reducing average nephrology waiting times from seven weeks in 2021 to four weeks in 2023-2024, despite a 27% increase in demand.
• Triage innovations have saved approximately £30,000 annually and reduced travel-related emissions by 14,000 kgCO2e.
• Additionally, remote monitoring has cut face-to-face follow-ups by two-thirds, saving 80,000 kgCO2e annually while freeing consultant time for complex cases, enhancing the efficiency of care delivery.

Patient Experience

Patient experience has significantly improved, as evidenced by survey data:

• 96% of participants noted an increase in their knowledge of CKD through the programme.
• 100% of users reported that Kidney Essentials was easy to comprehend and find relevant information, compared to 88% for equivalent written resources.
• A significant portion of respondents (29% Strongly Agree, 21% Somewhat Agree) expressed feeling more capable of managing their disease after using the companion.
• Average session time was 4 minutes 47 seconds.

“Putting patients at the centre of designing effective care delivery means focusing on their needs – ensuring they access the right care and information about their condition. Kidney Essentials, our digital education companion, has been pivotal in our outpatient transformation, enabling personalised, informed care. This tool is far-reaching in supporting CKD management in secondary care and, more importantly, in providing essential information to those newly diagnosed in the community. Secondary prevention plays a critical role in improving outcomes, and Kidney Essentials has been instrumental in this effort.” – Dr Emma Vaux, Consultant Nephrologist and Physician, Royal Berkshire NHS Foundation Trust

“The education programme has given me control of what has been bewildering, and given me hope that I can do something for myself to help myself going forward” – Patient

“I like having written information but watching it on a phone made it all feel a bit easier to get to grips with” – Patient

“This app provides high tech, high quality information making it more accessible to patients that struggle with literacy” – GP

“A brilliant culturally accessibly resource with language inclusivity which responds to the needs of the local community. Excellent co-production and consideration of digital exclusion.” – Comment from the shortlist panel of the BMA PLG patient information awards 2023

“An important, culturally sensitive resource with excellent co-production and noteworthy attention to language inclusivity and digital accessibility.” – Comment from the shortlist panel of the BMA PLG patient information awards 2023

 

Kidney Essentials: CKD was so well received by patients and clinicians in Berkshire, it was extended to a second phase, launched in September 2022. In the second phase, a new programme – Kidney Essentials: AKI – has also been developed using similar methods to support people with Acute Kidney Injury.

 

The design methodology:

A multidisciplinary co-creation approach was used (patients, nephrology, primary care, pharmacy and dieticians). Languages most appropriate for the Berkshire region were identified using data from local practice records regarding translator requests during patient consultations. To further improve accessibility, patient feedback from the pilot programme was assessed. User engagement was measured by time spent per session, and a digital feedback questionnaire assessed ease of use, effectiveness and patients’ preferences using a 5-point Likert scale, ranging from ‘No’ – ‘Sort of/It was ok’ – ‘Yes’.

Find out more

• Helping patients understand chronic kidney disease using technology – Renal digital playbook – NHS Transformation Directorate (england.nhs.uk)
• https://q.health.org.uk/idea/2019/the-virtual-hug-of-support

References:

1. Kidney Research UK (2023). Kidney disease: A UK public health emergency The health economics of kidney disease to 2033. [online] Available at: https://www.kidneyresearchuk.org/wp-content/uploads/2023/06/Economics-of-Kidney-Disease-full-report_accessible.pdf.

2. Taylor DM et al. Nephrol Dial Transplant 2018;33(9):1545-58;

3. Stømer UE et al. BMC Nephrol 20