Page 183 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

pressure measurements were correctly registered in the SMSS. In cases of non-correspondence between measured and registered values, the values that were registered in the SMSS appeared to be significantly lower than those actually measured. This suggests that patients select, alter or add values in such a way that their creatinine profile looks more positive. The percentage of patients following the advice that was shown automatically when a new creatinine value was registered in the SMSS ranged from 53-85%, depending on the specific feedback. The advice to contact the hospital, which was given in case level of creatinine had increased by >15%, was followed in only 58%. This is alarming as taking immediate action in case of early signs of graft failure is vital to prevent or diminish damage to the kidney transplant. Many patients had saved up their measurements over several days or weeks to register them all at once. With registering measurements retrospectively, the advice given by the SMSS was no longer up to date, which was probably the main reason why patients did not follow it. Patients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the automatic advice might challenge the safety of self-monitoring. This should be well considered when designing self-monitoring care systems, for example by ensuring that self-measured data is transferred automatically to an SMSS.
CONCLUSION
The studies that were performed and are described in this thesis show that self-monitoring kidney function after transplantation is an attractive option to kidney transplant patients and can lead to a significant decrease in number of outpatient visits without compromising on quality of care. Further, self-monitoring could offer a relatively cheap way to increase monitoring frequency, which could lead to earlier detection and treatment of complications and, consequently, improved clinical outcomes. But the results of these studies also show there is room for improvement. To unravel the full potential of self-monitoring kidney function after transplantation, it is recommended to use accurate measurement devices that both patients and healthcare professionals have confidence in, design a protocol with the involvement of a multidisciplinary group that is truly representative of all stakeholders (including patients and physicians that are more critical of self-monitoring) and choose a study design that includes formative evaluations instead of summative evaluations alone.
Summary 181