Urine testing at home

Smartphone powered urinalysis, enables people to do regular urine tests at home and securely share results with their clinician.

It tests for a range of infections, chronic illnesses and pregnancy-related complications. It is being used by Salford Royal NHS Foundation Trust with post-transplant kidney patients and by Modality Partnership with patients who have diabetes. They worked with Healthy.io whose app turns a smartphone camera into a medical device.

How was it developed?

The project in Salford was jointly led by the trust and Healthy.io working closely with a team of clinical leads, a GP and nurses. The team involved potential users to ensure it was as simple as possible for anyone to conduct the urinalysis test quickly and simply like a trained professional.

Usability and accuracy were tested in a real-life scenario. The service flow was adjusted as the project developed in response to patient behaviour and feedback. The teams involved worked together to provide joint project management collaboration and on the ground coordination to ensure a successful rollout and delivery of results.

Who is using it?

In Salford, it is being used by a cohort of post-transplant patients who regularly suffer from urinary tract infections (UTIs). They are sent Dip.io kits to their homes and told to take the test next time they present with symptoms of UTI. Once they take the test, the results are uploaded into a browser portal created by Healthy.io, and an email notification is sent to a mailbox monitored by the renal transplant clinic, informing the team so they can view the result. Patients are encouraged to ring the clinic once they’ve taken a test, and a nurse from the team will launch the portal to review and discuss the results with the patients. If the results indicate a UTI, they can be prescribed antibiotics without having to attend an appointment.

For Modality, the project was focused on Chronic Kidney Disease (CKD) screening for patients who have diabetes but haven’t had an ACR (a urine test measuring the amount of protein leaking from the kidney into the urine, and a sign of CKD) done in at least 12 months. Diabetes is a CKD risk factor and people with diabetes should undergo ACR tests annually.

Outcomes

In Salford, 24 patients were invited to take part in a study to assess use of the dipstick. Fourteen of these used it at home over six months.

There was only one admission for UTI in this patient group in these six months. As a result of the enhanced surveillance and rapid treatment, one patient stopped taking long-term antibiotic prophylaxis. Thirteen patients received antibiotics the same day as reporting symptoms.

Patients reported feeling empowered and were subjectively more engaged with their own management. One patient described the service as “simply marvellous, a true time-saver and easy-to-use without any problems… it’s great not to have to keep going in and out of my doctor’s practice”.

The trust says that nursing time spent managing UTIs has reduced considerably since using this direct testing.

Modality has tested with patients in the Hull and Airedale, Wharfedale and Craven region of Yorkshire. In the past, 65 per cent of patients here with diabetes had failed to provide samples for ACR testing. When offered the chance of a home-based test, seven out of ten (72%) used the Healthy.io kit - and one in ten were subsequently found to have signs of kidney damage.

An analysis by York Health Economics Consortium (YHEC) - a health consultancy and research organisation operated by the University of York - found that if the ACR home-based urine test was used across England, in just five years it would:

• save the NHS £660 million
• prevent 33,723 cases of CKD
• prevent 1,361 deaths
• spare 11,376 people from end-stage renal disease, when they require regular dialysis, or a kidney transplant