Page 14 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 1
care costs have been increasing more than the GDP[35] and are expected to increase further posing a risk for the sustainability of health care financing [36]. With more than 70% of the total healthcare expenditure being spent on chronic diseases[37], it is not surprising that efforts to decrease healthcare costs are mainly targeted at the management of chronically ill patients. Due to the positive effect of self-monitoring on healthcare spending [32-34], improving the self-monitoring skills of people with chronic conditions has become an important objective in chronic care management[5]. With the widespread availability of the Internet, self-monitored data can be easily shared and discussed with healthcare providers enabling the provision of care while patient and doctor are remote in place and even in time. This has made self-monitoring an attractive addition or alternative to regular care for many chronic conditions. Using the Internet to provide care at a distance is often referred to as eHealth. EHealth can bring efficiency to healthcare delivery, for example by reducing routine healthcare visits[38], and is therefore seen as a key solution to the challenge of rapidly increasing numbers of patients requiring chronic care.
The potential of self-monitoring and eHealth in (kidney) transplant follow-up
Recipients of solid organ transplantations have to pay frequent and usually routinely scheduled visits to the hospital to monitor graft function. As the onset of complications like acute rejection usually does not run synchronously with the monitoring appointment interval, it would be highly beneficial and efficient if patients could monitor graft function themselves. Studies regarding the potential of transplant patients self-monitoring health parameters at home have been mainly performed in a population of lung-transplant recipients. As these patients have an even higher risk for acute rejection and infection than recipients of other solid organs[39, 40], they need to frequently self-monitor vital signs to enable early detection of changes in their condition. Self-monitoring with electronic devices and the support of technology systems has been shown to be a valid and reliable way to detect complications after lung-transplantation early[41, 42] and to lead to better survival[43] and a higher quality of life for lung-transplant patients[44].
Self-monitoring may also be a promising approach for kidney transplant follow-up, with the frequent and usually routinely scheduled appointments to monitor kidney function being highly burdensome to the recovering patient and to healthcare resources. Although significant improvements in kidney transplant outcome have been achieved in the last decade [45], patients continue to be at risk for acute rejection of their kidney graft, mainly in the first year after transplantation. As early detection of a rejection episode is mandatory to minimize permanent damage to the kidney graft[46-51], kidney transplant patients in the Netherlands visit the outpatient clinic about 20 times during the first year post-transplantation. Despite the high frequency of outpatient visits, the potential of self-monitoring