Page 13 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

(either digitally or with paper and pencil) to track symptoms. It is important that patients closely monitor their condition themselves, as chances are very small that the onset or worsening of symptoms happens just prior to the few moments that ‘the other pilot is on board’. If patients keep track of their own condition, exacerbations, complications and potentially even death can be prevented[6].
The (potential) merits of self-monitoring in chronic conditions
The concept of self-monitoring has been mainly studied and applied in conditions that need frequent monitoring to achieve optimal medication management. For example, diabetic type 1 patients need to monitor their glucose level several times a day to adjust their insulin doses. It would be extremely burdensome for both patients and healthcare capacity if these measurements could solely be performed by healthcare staff. It is therefore not surprising that the idea of diabetics self-testing goes back to the mid-1970s[7]. The first study in which self-monitoring blood glucose (SMBG) was successfully applied was performed in 1978[8]. Since then, many studies have followed showing that self-monitoring can lead to reductions in HbA1c[9-12] in patients with diabetes. This has resulted in the universal recognition of SMBG to be an essential element of optimal type 1 diabetes management[13]. Much experience with self-monitoring has further been gained on the usability of self-monitoring International Normalized Ration(INR) [14-19]. INR is an assay to determine the clotting tendency of blood, which is important information for patients with thrombosis who receive oral anticoagulant therapy. Due to the narrow target ranges, INR needs to be frequently monitored in order for anticoagulant medication to be appropriately dosed[16]. Studies have shown that with self- monitoring INR, the number of thromboembolic events in this population can be reduced [15, 16]. In other disease populations, self-monitoring has also been shown to be beneficial: patient self- monitoring blood pressure has a positive impact on the management of hypertension [20-24] and self- monitoring asthma symptoms can lead to improved asthma control [25]. Further, several studies in different disease populations have shown that patients who self-monitor experience higher levels of quality of life[26-29] and more empowerment[14, 18, 29-31] than patients who do not. In addition, patients seem to prefer self-monitoring above regular care in a variety of chronic conditions[14, 18, 23, 26, 27, 29].
Besides being beneficial for the individual patient, self-monitoring has also been shown to offer a way to control volume and costs of chronic care[32-34]). There are great concerns that the increasing numbers of chronically ill will outgrow the capacity of the working-age population to both finance the public health spending and fulfil the healthcare capacity needs. In the last decennium, 10% of the gross domestic product (GDP) in the European Union is spend on health care. Moreover, the health
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