Page 145 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

Self-monitoring: the reliability of patient-reported data 143
measurements during month 2-4 after transplantation. Adherence was lower during the first month when more measurements were requested and months 5-12 after transplantation when less measurements were requested, with about 75% and 85% of patients adhering to the requested number of measurements, respectively. Overall adherence to registration of measurements was about 10% lower than adherence to performance of measurements during all phases. Two studies reporting on level of adherence to monitoring vital signs after lung transplantation found similar percentages of adherence being above 80% for the entire study period[24, 26]. For self-monitoring blood pressure, patients with uncontrolled hypertension were shown to be adherent for about 73% of the entire study period[25, 29]. In both studies, level of adherence was highest in the first few weeks and declined gradually over time. In sum, mean level of adherence that has been found in the current study corresponds to percentages that have previously been reported. In contrast, we did not find the highest levels of adherence in the first period. This may have been due to a strenuous measurement protocol. Patients had to measure every day in the first month. In these first weeks when patients have to recover and have to get used to life post-transplantation, performing measurements in such a high frequency might be too burdensome. Further, in this first period face-to-face visits were not yet replaced by telephonic consults and patients therefore visited the hospital at least weekly to monitor early signs of graft failure. Due to this high frequency of visits, patients may have felt a reduced need to perform measurements at home, as they did not have to rely on these measurements. The latter may also be an explanation for non-adherence during the whole study period.
Further, for self-monitoring to be a safe alternative to regular face-to-face follow-up, patient-reported test results need to be accurate. In the current study, approximately 90% of both creatinine and blood pressure measurements was registered correctly in the SMSS. This percentage corresponds to what has previously been described for patient-reported blood pressure[29, 37] and anticoagulation[34] and is much higher than has been observed for patient-reported levels of blood glucose. A study by Kalergis and colleagues[30] for example, showed that slightly over half of the total group of patients with either diabetes type 1 or 2 was considered very reliable in their reporting. For patients with diabetes type 2 and for pregnant women self-monitoring blood glucose, some studies even showed that the majority of patient-reported data was unreliable[31, 32].
In cases of non-correspondence between measured and actually registered values, values that were eventually registered in the SMSS were significantly lower than those actually measured. These results seem to suggest that patients select, alter or add values in such a way that their creatinine profile looks more positive. This corresponds to what has been found in a population of patients with thrombosis, where the percentage of time patients’ level of anticoagulation was within the desired range was
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