Development of a Smartphone Application to Enable Remote Monitoring in the Outpatient Management of Cirrhotic Ascites

DOI: https://doi.org/10.29086/JISfTeH.6.e7

  • Phil Ha Monash Health
  • Sherryne Warner Monash Health
  • Paul O’Neil Monash Health
  • Patricia Anderson Monash Health
  • William Sievert Monash Health
Keywords: Health, remote monitoring, cirrhosis, ascites

Abstract

Patients who develop hepatic decompensation with ascites have a poor prognosis and often experience other complications including spontaneous bacterial peritonitis, hepatic encephalopathy and variceal bleeding. We hypothesised that smartphone (SP)-enabled remote monitoring of patients with ascites may enable early detection of infection and acute decompensation, facilitate timely intervention and improve patient outcomes. Aim:  We aimed to design, develop and implement a remote monitoring system (RMS) for outpatients with cirrhotic ascites. Method: We undertook surveys with patients and hepatologists to quantify the demand for a RMS and identify issues regarding implementation. A smartphone and a web-based application were developed as a RMS. Patients used the RMS in a 6-week prospective non-randomised trial.  Results: We surveyed 27 patients (mean age 56 years, 18 (67%) were male, 16 (59%) had Childs Pugh B cirrhosis, and 20 (74%) had a history of alcoholic liver disease) and 5 hepatologists. There were 19 patients (70%) who reported that they would use a RMS. The RMS was used by 10 patients for a mean 53.8days (11-70), who entered 20.6 (0-71) updates. A total of 18 automated alerts occurred. 22% of automated alerts resulted in clinically significant changes to management, such as inpatient admission n=1 (6%), early outpatient appointment n=1 (6%) and reinforced adherence n=2 (11%). Conclusion:   We have successfully designed an internet-enabled RMS for outpatients with cirrhotic ascites that could be used as an adjunct to existing outpatient services. Future studies will optimise the alert thresholds, assess long-term patient adoption and quantify clinical impact.

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Published
2018-03-29
How to Cite
Ha, P., Warner, S., O’Neil, P., Anderson, P., & Sievert, W. (2018). Development of a Smartphone Application to Enable Remote Monitoring in the Outpatient Management of Cirrhotic Ascites. Journal of the International Society for Telemedicine and EHealth, 6(1), e7 (1-9). https://doi.org/10.29086/JISfTeH.6.e7
Section
Original Research