Page 129 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint
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 Self-monitoring: the reliability of patient-reported data 127
For the current study, only participants randomized to the intervention group were included.
Intervention
Devices and Self-Management Support System (SMSS)
For self-monitoring creatinine, each participant received a StatSensor® Xpress-iTM Creatinine Meter (Nova Biomedical, Waltham, USA) and related test material (i.e. test strips, control solution to test the quality of the strips, and safety lancets for capillary blood sampling. Based on a drop of blood of 1.2 μL, the StatSensor® can show either current level of creatinine or eGFR. As at our medical centre clinicians usually communicate level of creatinine to kidney transplant patients, the device was set to show creatinine.
For self-monitoring blood pressure, each participant received a Microlife WatchBP® Home (Microlife, Heerbrugg, Switzerland), an oscillometric device for blood pressure self-measurement on the upper arm. Both devices had a memory function and the option to download stored values to a computer. An online self-management support system (SMSS) was available for all patients in the intervention group. This SMSS entailed an eLearning module instructing patients on how to use the SMSS system, that is (a) how to perform creatinine measurements at home, (b) how to register self-measured values in the SMSS (both creatinine and blood pressure), and (c) how to respond to messages from the automatic feedback system to support patients’ interpretation of the creatinine trends. Figure 1 provides an overview of the feedback process. The feedback appeared directly after registration of a new creatinine value online and consisted of a traffic light with corresponding text. Per day, a maximum of two creatinine values could be registered. After registration of the first value of the day, a green light indicated that there was no reason for concern and was associated with the advice to just continue regular measurement frequency. This was termed the day conclusion, as no further actions were required for the concerning day. The appearance of an orange or red light (in case the newly registered value was respectively >15% or >20% higher than mean of the previous five values) directly after registration of the first value of the day indicated that there was some reason for concern. The system’s advice was then to perform and register a second measurement to confirm the first measurement. This was termed action feedback, as it required an immediate action. After registration of a second measurement, an appearing green light indicated that there was no further reason for concern. In this case, patients were advised to continue their regular monitoring frequency. Alternatively, an orange light indicated that there was some reason for concern and patients were advised to measure again tomorrow. Finally, a red light indicated that there was reason for concern and patients were advised to contact the hospital. Feedback given after the registration of a second
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