Automated Digital Counseling Program (ODYSSEE-Kidney Health): A Pilot Study on Health-Related Quality of Life

Abstract

Key Points:

1. Feasibility of implementing an automated, scalable, digital self-care program for patients with CKD was established.

2. The primary outcome of improvement in health-related quality of life improved with the ODYSSEE-Kidney Health program.

3. A dose relationship was shown between program engagement tertile and improvement in 4-month outcomes.

Background: In-person counseling programs promote self-care behavior and health-related quality of life (HRQoL). ODYSSEE-Kidney Health (prOmoting health with DigitallY based counSeling for Self-care bEhavior and quality of lifE; ODYSSEE-KH) is an automated, scalable, digital counseling program for patients with CKD. This open-label, single-arm pilot study tested the efficacy potential of the ODYSSEE-KH program to improve HRQoL in patients with CKD.

Methods: Adults with categories G3b to 5d CKD were recruited from nephrology clinics in Toronto, Canada. Patients (N=29) received access to the ODYSSEE-KH program in conjunction with usual care. Generalized linear models and pairwise comparisons of mean change scores were conducted to assess the primary outcome: Mental Component Score (MCS) of the Kidney Disease Quality of Life–Short Form instrument. Secondary outcomes included the MCS Mental Health Scale, 36-Item Kidney Disease Quality of Life–Short Form, Generalized Anxiety Disorder Scale, Patient Health Questionnaire for depression, Enhancing Recovery in Coronary Heart Disease Social Support Instrument, and 3-Item Revised University of California, Los Angeles (UCLA) Loneliness Scale.

Results: The mean age of the patients was 53.5 years (SD=18.3); 35% were women; 56% were White; 93% had completed ≥postsecondary education; patients came from the Multi-Care Kidney Clinic (n=9), Home Peritoneal Dialysis Unit (n=12), and Home Hemodialysis Unit (n=8); and 24 participants completed the 4-month end-of-study questionnaires. Outcomes were assessed according to tertiles of program log-on minutes: median (range)=67 (62–108), 212 (119–355), and 500 (359–1573) minutes, respectively. Patients in the highest tertile of engagement showed significant improvements on the MCS versus the moderate tertile group (P = 0.01). Significant dose-response associations were observed for the MCS Mental Health Scale (P < 0.05), KDQoL Burden on Kidney Disease (P < 0.01), KDQoL Effect of Kidney Disease on Everyday Life (P < 0.01), aggregated KDQoL Summary Scale (P < 0.05), Generalized Anxiety Disorder Scale (P < 0.01), Patient Health Questionnaire for Depression (P < 0.05), Enhancing Recovery in Coronary Heart Disease Social Support Instrument (P < 0.01), and 3-Item Revised UCLA Loneliness Scale (P < 0.01).

Conclusion: The ODYSSEE-KH program demonstrated feasibility as an automated, scalable, digital self-care program for patients with CKD. There is evidence of its efficacy potential to improve HRQoL. Further evaluation with a larger sample is warranted.

Conflict of interest statement

B.L. Auguste reports the following: Employer: Sunnybrook Health Sciences Centre; Honoraria: Amgen and Baxter Healthcare Canada; and Other Interests or Relationships: Canadian Society of Nephrology Member and International Society of Nephrology. C.T. Chan reports the following: Consultancy: Dialco, Medtronic, and Quanta; Research Funding: Medtronic through their external grant program; and Advisory or Leadership Role: DaVita, Medtronic, and Quanta. A.G. Logan reports the following: Research Funding: Philips Respironics; and Patents or Royalties: Aljanex Medical Consultants Ltd. All remaining authors have nothing to disclose.

Figures

Graphical abstract

Figure 1

Schematic summary of the pilot study protocol.

Figure 2

Flow diagram of patients approached to participate in the pilot study.