Page 161 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

place in 2010 and early 2011, the RCT started early 2012. Considering the speed of technological developments and digitalization of our society, the finding that several doctors were somewhat hesitant towards using the SMSS system will probably no longer be representative anno 2018, as doctors are now more used to delivering part of their care in a digital way. Besides the lack of experience with eHealth at that time, some other potential causes for the limited SMSS use can be distinguished. First, some of our doctors were critical about the accuracy of the creatinine device that was used. It has been concluded before that doctors need to feel confident in order to be able to share some of the control with patients[37] and that diagnostic confidence is key to incorporating remote monitoring into the transplant clinic[38]. In addition, as many patients brought a handwritten note with their recent measurement results to the consultation, most doctors might have considered discussing the paper print as being less time-consuming than logging on to the SMSS. Although access to the SMSS was integrated into the hospital information system, actually obtaining the data required an additional step. Both routine and time have been shown to be important factors in the adoption of new ways of delivering care[37, 39, 40]. Third, during the kick-off meeting for this study, many doctors stated that ‘there is more to outpatient care of kidney transplant patients than checking creatinine and blood pressure’. Doctors generally feel highly responsible for ensuring that high-quality care is achieved[37, 40, 41] and using patient acquired creatinine and blood pressure only may have clashed with their perception of professional responsibility.
Fourth, the (potential) benefits of self-monitoring kidney function at home are less obvious for doctors than for patients. In a recent paper describing the development of a conceptual model for the design and evaluation of eHealth interventions in chronic disease, it was stated that it is important to emphasize the role that eHealth can play to support healthcare providers[42]. In the current study, some doctors requested for prolonged use of the creatinine device in case a transplant patients’ condition was unstable or requested the use of the creatinine device for non-transplant kidney patients for whom increased kidney function monitoring was required. In these cases, self-monitoring made it easier for doctors to keep closer track of their patients’ condition without having to increase the number of laboratory analyses and outpatient visits. Especially indicative for the importance of perceived usefulness is the finding that one of the doctors who was more critical of self-monitoring and had never logged on to the SMSS asked for the use of the creatinine device for a non-transplant patient. This may illustrate that healthcare professionals’ perception that self-monitoring is really supportive to their care is indeed important for their readiness to use patient generated data.
General discussion 159
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