Page 126 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 6
ABSTRACT
The high frequency of outpatient visits after kidney transplantation is burdensome to both the recovering patient and healthcare capacity. Self-monitoring kidney function offers a promising strategy to reduce the number of these outpatient visits. The objective of this study was to investigate whether it is safe to rely on patients’ self-measurements, using data from a self-management RCT.
During the first year post-transplantation 54 patients registered their self-measured creatinine values in an online Self-Management Support System (SMSS) which provided automatic feedback on the registered values (e.g. seek contact with hospital). Values registered in the SMSS were compared to those logged automatically in the creatinine device to study reliability of registered data. Adherence to measurement frequency was determined by comparing the number of requested with the number of performed measurements. To study adherence to provided feedback, SMSS logged feedback and information from the electronic hospital files were analysed.
Level of adherence was highest during month 2-4 post-transplantation with over 90% of patients performing at least 75% of the requested measurements. Eighty-seven percent of all registered creatinine values was entered correctly, although values were often registered several days later. If (the number of) measured and registered values deviated, the mean of registered creatinine values was significantly lower than what was measured, suggesting active selection of lower creatinine values. Adherence to SMSS feedback ranged from 53-85% depending on the specific feedback.
Patients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the feedback provided by the SMSS might challenge safety. This should be well-considered when designing self-monitoring care systems, for example by ensuring that self- measured data are transferred automatically to a SMSS.