Publications
Loyalty Chain have had the following research projects published
An analysis of time taken to review Automated Peritoneal Dialysis (APD) patient daily record books and the value associated with this type of monitoringWilson K, Main C, Knowles M
Baxter Healthcare Ltd, Compton UK
Loyalty Chain Ltd, Repton UKAbstract: Patients undertaking dialysis at home are expected to keep records in order for Healthcare Professionals to monitor therapy and modify treatment. Tracking therapy ensures patients are adequately dialysed and clinical outcomes are optimised. Some dialysis programmes also use Pro Cards to collect data direct from the patient’s dialysis machine.
In other chronic disease areas the use of telemedicine and remote patient monitoring are being evaluated as an alternative means to monitor patients.
Real time observation of nurses in clinic, structured patient telephone interviews and an online survey for PD Nurses was used to understand the time associated with and the value of reviewing patient records.
1.Nurses spend only 5% of their time proactively managing patients.
2.Patients report that monitoring through review of records gives them confidence to undertake dialysis at home.
3. Despite the value of such monitoring, only 27% of patients had their records reviewed during clinic visits.
Whilst patient monitoring today is considered valuable by both patients and nurses, it may not currently be optimised to improve clinical outcomes at home. The study will be repeated after the introduction of the Sharesource remote patient management system to evaluate if such a system may change the impact of monitoring on patient management and clinical outcomes. June 2016 (British Renal Society) To view the full article
Homecare support to improve adherence in multiple sclerosis
Mary Roper Knowles - Loyalty Chain Ltd British Journal of Neuroscience Nursing (2011)Abstract: There are approximately 100 000 people in the UK who have been diagnosed with multiple sclerosis (MS). Long-term adherence by patients to the widely used treatment disease modifying therapies (DMTs) can be a challenge. The aim of this survey was to understand the critical points of contact where homecare support could impact adherence and provide suggestions to improve the homecare support services provided to MS patients. Homecare support is defined as any sponsored patient support programme from a homecare company. Surveys were sent to 5 025 MS patients and 150 MS nurses working within the NHS. Completed survey responses were obtained from 1 868 MS patients (37%) and 42 MS nurses (28%). Patients and specialist nurses reported that training and support in the early stages of treatment could influence adherence, particularly when that training is tailored specifically to the patients’ requirements and unlimited by time and resources. Key Words Multiple sclerosis, patient satisfaction, adherence, homecare services, patient training, evaluation Author Mary Roper Knowles is managing director, Loyalty Chain Ltd
Accepted 8 April 2011 This article has been subject to double-blind peer review To view the full article
The impact of remote management with patient’s receiving Automated Peritoneal Dialysis (APD) on frequency and duration of routine Nephrology Outpatient attendanceWilson K, Meagher M, Knowles M
Baxter Healthcare Ltd, Compton UK
Loyalty Chain, Repton UKAbstract Patients undertaking their dialysis at home with Automated Peritoneal Dialysis (APD) have regular contact with Healthcare Professionals (HCP’s) through attendance at routine Nephrology Outpatient Clinics.Review of patients dialysis treatment data is an important part of patient management. Traditionally patients present for clinic attendance and their paper dialysis records are reviewed during the consultation.Following the introduction ofremote patient management technology (Sharesource), HCP’s are able to see patient’s dialysis treatment data more regularly and in advance of a scheduled clinic visit. Following its introduction, patients reported a reduction in both the frequency and duration of clinic visits.Despite this reduction, patients felt completely confident undertaking their dialysis at home. April 2017 (British Renal Society) To view the full article
The Impact of Automated Peritoneal Dialysis (APD) with Remote Patient Management (RPM): Changing the Nursing Paradigm to Proactive Clinical Management. Catherine A. Firanek
Mary A. Knowles
James A. SloandBaxter Healthcare Corporation, Deerfield, IL;
Loyalty Chain, Ltd., Repton, United KingdomBackground
Patients receiving APD are required to record details of their PD therapy and clinical data on a daily basis. This data is reviewed by the PD nurse at the time of the clinic visit as part of the overall patient assessment. The introduction of new APD cyclers embedded with two-way RPM technology offers the ability to monitor PD therapy, allowing nurses to view patients’ dialysis details on a daily basis and/or make prescription changes remotely as needed. This technology enables nurses to review and proactively manage clinical issues and prescription changes, rather than manage care in what has heretofore been predominantly reactive. Two-way RPM provides opportunity for early intervention of dialysis-related issues and the ability to prioritize patients effectively
Objective
The aim of this study was to evaluate the impact of RPM on nurses’ behavior and practice in the care of patients on APD at home. In particular, the study assessed if changing the frequency that the patient’s dialysis details are remotely viewed by nurses impacts their ability to manage patients proactively. Difference in time taken to proactively versus reactively manage patients before or after the introduction of RPM was established within their hospital.
June 2017 (European Dialysis and Transplantation Association)
To view the full article
Influence of an Automated Peritoneal Dialysis (APD) Cycler-embedded Remote Patient Management (RPM) Platform on Time Spent by Nurses on Perceived Higher-Value Interactive Tasks with Patients
Catherine A. Firanek 1
Mary A. Knowles 2
James A. Sloand 1
1 Baxter Healthcare Corporation, Deerfield, IL
2 Loyalty Chain, Ltd., Repton, United KingdomIntroduction
Peritoneal Dialysis (PD) initiation by incident patients with End Stage Kidney Disease requires that patients have a sense of self- confidence and safety in performing home dialysis. In large part, this is conveyed by nurse interaction. 2-way cycler-embedded Remote Patient Management (RPM) allows nurses to securely view recently completed home dialysis-related treatment data, proactively manage clinical issues, and make prescription changes remotely, potentially averting negative clinical outcomes. The impact that cycler-embedded RPM has on shifting nurse and patient training/interactions to higher-value interactions that engender patient self-confidence/safety is unknown. Objectives
To understand changes in nursing time used to implement perceived high-value patient-related interactions before and after RPM introduction. September 2017 (European Peritoneal Dialysis Meeting) To view the full article
Using a Remote Two-Way Patient Management System to Tailor APD TherapyKate McCarthy 1
Mary Roper-Knowles 2
1. Baxter Healthcare Ltd, Compton, UK
2. Loyalty Chain Ltd, Repton, UKAbstract: Introduction:
Sharesource is a 2-way remote patient management platform, that allows the PD team to securely view their patients recently completed home dialysis treatment data; enabling early detection of treatment-related issues and proactive remote adjustment to home device settings.
Objective:
To evaluate the impact of Remote Patient Management (RPM) on PD resource utilisation, nursing decisionmaking and individualised tailoring of patient care.
Method:
The same Renal Nurses were observed during ordinary working days within Renal Units pre and post Claria Sharesource introduction.
Results:
A total of 2,187 minutes of PD nursing time was observed pre and post Claria Sharesource introduction. Pro-active nursing behaviour increased; frequency and length of clinic visits decreased; valued tasks increased; and clinicians reported improved patient care.
Conclusion:
The reduction in routine tasks in conjunction with increased overview of the PD patient cohort, allows better time management and the ability to prioritise patients’ needs UKKW June 2018 To view the full article
LoyaltyChainLoyalty Chain works with organisations to improve customer loyalty. This is achieved through analysing and measuring the critical links that enable organisations to achieve greater profitability by understanding and controlling repeat business from its customers.
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