Page 146 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 6
significantly higher when using patient-reported data compared to data stored in the device[34]. For patients with diabetes or hypertension, it was found that inaccurate reporting increased with increasing levels of blood glucose[31] or blood pressure[37]. Why patients report values that look better than the actual measured values or add non-existent measurements has not yet been fully clarified. For diabetes, it has been suggested that patients report false glucose levels due to a feeling of guilt for not having achieved glycemic goals[32] or add phantoms values in an attempt to fill up logbooks and satisfy their healthcare providers[30]. Both situations seem to represent an attempt to be a ‘good’ patient. However, altering and selecting data that is not representative of the actual clinical situation or adding phantom values in any case may be dangerous. This can lead to suboptimal treatment and, eventually, to worsened patient outcomes[30, 37]. In a study by Kendrick and colleagues it was found indeed that women with pregnancy-derived diabetes received suboptimal treatment due to a large difference between their reported glucose values and what they had measured[32]. Results of another study showed that diabetic patients who were more reliable in their reporting had a significantly better glycemic control. It was suggested that this may be due to the ability of clinicians to adjust therapy more precisely if measurements are reported accurately[30]. To prevent incorrect reporting, it has been recommended to rely on the memory capacity of measurement devices, preferably by using devices that can transfer data automatically[30, 31, 33, 34].
Besides eliminating the occurrence of both intentional and unintentional errors, the automatic transfer of data offers a solution for the observation that patients seem to save up their measurements before registering them. Many patients saved up their measurements over several days or even weeks to register them all at once. More than one-third of our participants displayed a mean delay of 5 or more days between measurement and registration of data. This is alarming as frequent monitoring and taking immediate action in case of early signs of graft failure is vital to prevent or diminish damage to the kidney transplant. An explanation for saving up measurements before registering them might be that the measured creatinine values remained stable. However, patients seemed to postpone registration regardless of the stability of their kidney function. Indeed, postponement of registration appeared to be the main reason why patients had not followed up the advice to contact the hospital when creatinine levels had alarmingly increased by over 15%. Patients’ perception of these significant increases could have been influenced by the fact that the innovative device that was used during this study tended to be less accurate than hospital laboratory measurements[35]. As a consequence, patients might have been inclined to attribute sudden increases in level of creatinine to a technical imprecision of the device.