Page 107 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

Self-monitoring of renal function: a randomised trial 105
creatinine, a feedback system was available. The feedback appeared directly after registration of a new creatinine value and consisted of a traffic light with corresponding text to support interpretation (see figure 1). Values registered in the SMSS were automatically sent to the electronic hospital system and thus visible for the treating nephrologist(s).
The SMSS further entailed an eLearning module with measurement instructions and information on kidney anatomy, the transplantation procedure, medication and lifestyle.
2.3. Intervention procedure
After being instructed through eLearning, all intervention patients received the self-monitoring devices and supplementary instructions. Patients were carefully instructed that they were supposed to take action themselves upon the system’s feedback, as their nephrologist(s) would not systematically check registered home-based values. Patients were encouraged to practice using the creatinine and blood pressure devices during the remainder of their hospital stay. Home-based measurements had to be performed according to a fixed frequency, being daily during the first 4 weeks (phase 1), every other day for week 5-9 (phase 2), twice a week for week 10-15 (phase 3) and weekly from week 16 onwards (phase 4). This scheme was based upon the usual frequency of laboratory testing, which gradually decreases after time.
For intervention patients, every other face-to-face (ftf) visit with regular hospital-based laboratory analysis was replaced by a telephonic consult to discuss self-monitored creatinine and blood pressure from week eight after transplantation on. A reminder for nephrologists to schedule a telephone consult instead of a ftf visit was shown repetitively in the patients’ electronic hospital file. The treating nephrologist eventually decided whether a patients’ clinical condition allowed for a ftf consult to be replaced by a telephonic one. The control group received standard care, excluding the use of a creatinine device at home. All their follow-up appointments took place in the outpatient clinic of the LUMC.
In addition, 20 patients were interviewed concerning their experiences and satisfaction with self- monitoring kidney function after transplantation using a semi-structured protocol (see appendix). Over time both intervention and control patients completed questionnaires, a baseline questionnaire at day of discharge and twelve months after discharge.
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