Page 118 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 5
similar trend for home-based and laboratory-based creatinine levels in 78% of all available cases, which is 10% higher than what has been reported before[34]. Five intervention group patients experienced a rejection episode. In three cases, the developing rejection was detected before the scheduled control appointment due to the creatinine measurements performed at home, while no rejection episode was missed.
This study shows that self-monitoring kidney function at home can safely reduce the high number of outpatient visits post-transplantation. This is beneficial for both patients and the health care system. Patients can save time and effort during their recovery from the transplantation and in the longer term, having to pay less visits to the hospital limits the interference of post-transplant follow-up with daily life. Further, the lower amount of outpatient appointments will reduce the burden on health resources and healthcare budgets. The actual difference in number of outpatient visits between the intervention and control group was, however, smaller than expected. Other studies have also reported that reductions in regular care using telehealth were lower than expected[35, 36]. Leimig et al.[36] state that this is most likely due to patients’ hesitancy to lose ftf contact with healthcare professionals and hesitancy of the clinic personnel to use the telehealth equipment[36]. Our data are in concordance with this description, but only regarding the health care professionals. We observed a hesitance in the doctors to replace ftf visits with telehealth, despite the fact that these professionals were fully trained in the protocol. Two potential causes for the limited SMSS use by doctors can be distinguished. First, some of the doctors were critical about the accuracy of the creatinine device that was used. It has been concluded before that doctors need to feel confident in order to share control with patients[37] and that diagnostic confidence is key to incorporating telehealth into a transplant clinic[36]. Second, during the kick-off meeting for this study, several doctors stated that ‘outpatient care of kidney transplant patients goes beyond checking creatinine and blood pressure’. Doctors generally feel highly responsible for ensuring that high-quality care is achieved[37-39] and using self-reported and patient acquired creatinine and blood pressure data may interfere with their perception of their professional responsibility. It is therefore important to emphasize that self-monitoring and telehealth can support doctors in their delivery of healthcare instead of competing with it[40].
The hesitations regarding self-monitoring did not seem to apply to patients. Patients were very positive about self-monitoring kidney function after transplantation, taking into account the near unanimous recommendation of self-monitoring to other kidney transplant patients. High levels of satisfaction with self-monitoring have been found before[8, 15-17, 41]. In these studies, however, self-monitoring patients also reported a higher level of general satisfaction than their fellow patients receiving regular care. This was not confirmed in the current study. Level of satisfaction measured with the CSQ was