An initiative harnessing smartphone technology to enable early identification of people with diabetes at risk of developing chronic kidney disease has been rolled out successfully across South East England thanks to a collaboration led by AHSNs. Initiated in the north of England, take up of the self-management innovation is spreading across England thanks to AHSNs working with health systems within their regions. The diagnostic developed by Healthy.io is producing better outcomes, relieving NHS cost and resource pressures and supporting environmental sustainability. Instead of an appointment at their GP surgery, patients carry out a simple urine test at home and share the results securely with their GP using an app on their own phone.
What is the challenge?
People with diabetes are at greater risk of complications including chronic kidney disease (CKD). NICE Guidelines (CG182) recommend that they should monitor their kidney health with an annual test of their albumin to creatine ratio (ACR). This test indicates previously unknown CKD in around one in four cases. Unfortunately, only about half of the people who should take the annual test do so – and this proportion fell further through the pandemic. This increases the risk of CKD being missed until it becomes symptomatic and much more serious resulting in dialysis, transplant or even death. Missed ACR tests could affect tens of thousands of people in the Oxford AHSN region alone.
An independent evaluation commissioned by the Yorkshire & Humber AHSN showed the NHS could save £209m in care costs over five years through national adoption of a home test model for people living with diabetes. Extending the test to other at-risk groups, like people with hypertension, could significantly increase these savings.
What did we do?
“Minuteful Kidney” developed by Healthy.io is enabled through a smartphone app which reads the ACR urine test then securely shares the results with the relevant clinician, allowing a shift of this pathway from primary care to the patient’s home. It is a novel pathway change as part of the Covid recovery programme. Uptake is supported by an NHS AI in Health and Care Award, which pays for the cost of the product for the first 12 months of adoption.
NHS Priorities and Operational Planning Guidance for 2022/23 includes a focus on reducing backlogs, reducing GP workload and remotely managing patients with new pathways. The Minuteful Kidney test has the potential to support all these initiatives.
The three AHSNs in the South East (Oxford, Wessex and Kent Surrey Sussex) agreed a coordinated course of action, supporting wider adoption of Minuteful Kidney, following initial success through Yorkshire & Humber AHSN. The Oxford AHSN enabled discussions between NHS commissioners in Berkshire and Healthy.io which led to full coverage across the South East.
What has been achieved?
Data published by Healthy.io following adoption of the Minuteful Kidney test in the South East shows:
• an increase in compliance with an annual ACR test within the CKD “at risk” group from 54% to 79%
• 85% of patients agree to take the test when contacted by the Healthy.io patient support team
• Previously unknown CKD is indicated in 25% of cases where elevated protein is detected, meaning more patients can start to receive appropriate interventions sooner
• 96% of patients report that the Minuteful Kidney test is “easy” or “very easy” to use.
As the test is sent to the patient to use in their own home and the results transferred securely to their GP electronically, use of the Minuteful Kidney test is also expected to save tens of thousands of patient journeys for appointments with their GP, thereby also reducing the environmental impact of healthcare delivery and contributing towards the NHS Net Zero ambition.
What people said
“Using their network of contacts, the Oxford AHSN was able to successfully open crucial discussions with stakeholders at Berkshire West and support the importance of the ACR project. Their involvement has led us to be introduced to engaged key stakeholders, opening up the opportunity for remote ACR testing in this area.”
Ashley Le Cudennec, Regional Commercial Manager Healthy.io (UK)
Planning for the adoption of Minuteful Kidney is still in progress in parts of the Oxford AHSN region. The true impact will become clear in 2023.
Guy Checketts, Head of Transformation, Oxford AHSN [email protected]