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Smartphone-powered home urine test improves adherence to ACR testing in patients with diabetes

Case Study

Overview’s ACR ‘Adherence as a Service’ enables people to test their urine at home using a test kit and accompanying app. The service improved adherence to ACR testing from 0% to 73% in consented patients with diabetes who had been offered the traditional model of care multiple times but did not attend. This helped identify abnormal ACR in 24% of the patients that tested, that might not otherwise have been identified.


of those tested had an abnormal or high abnormal result, indicating previously unknown albuminuria


of contacted patients who agreed to recieve a kit completed an ACR test at home


of patients agreed the service was easy to use


preferred home testing to attending the clinic

The Challenge

An abnormal ACR test is an independent risk factor for both cardiovascular and chronic kidney disease (CKD), yet it is often the worst-performing of all NICE recommended diabetes care processes.

The project was offered to patients living with diabetes in three practices in Barking & Dagenham CCG, in collaboration with Care City as part of the NHS England Test Bed. Barking & Dagenham CCG is a diverse borough of London, with high levels of social deprivation, a relatively young population, and a high prevalence of diabetes in comparison with England; therefore, strategies to improve care and treatment outcomes must be sensitive to the needs of different communities and be highly accessible.

Patient onboarding

Patients were contacted by’s patient onboarding team, who provided information about the service, the importance of annual ACR testing, and supported patients to download the app.

Self-testing at home

Patients who consented to take part were sent a kit at home and a link to download an app that talks them through the process of home testing.

Results and follow-up

After completing the test, the results were available in EMIS, the local electronic patient record system, for clinician review. Patient follow-up was initiated based on the ACR results.


Clinical Impact
Clinical Impact

Home testing demonstrated an increase in adherence to ACR testing in patients with diabetes. 73% of patients contacted agreed to receive a kit, completed an ACR test at home (45% of eligible patients) and 24% of those tested had an abnormal or high abnormal result, indicating previously unknown albuminuria.

Patient Impact
Patient Impact

Allowing people to test from home resulted in an improved patient experience. 97% of patients agreed the service was easy to use and 89% preferred home testing to attending the clinic

Financial Impact
Financial impact

If the service was scaled to all patients with diabetes and no ACR recorded, it would result in projected savings for Barking and Dagenham CCG of £35,727 in year 1 and £1,099,727 in year 5. The projected savings for NHS England are £7,600,711 in year 1 and £233,960,125 in year 5. Projected savings are driven by early identification and intervention of CKD, reduced progression to ESRD and prevention of complications.

The service enabled our patients with diabetes to monitor their kidney function at home whilst self isolating; a crucial part of their long term care."

Dr Anju Gupta, Diabetes Clinical Lead ,Barking and Dagenham CCG

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Citations and Footnotes
  1. Assuming 62% consent rate and 73% test completion rate. Based on York Health Economics Consortium (YHEC) financial modeling data from the 2019 National Diabetes Audit.