Page 165 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

number of visits between intervention and control patients would have been six. The actual difference between intervention and control group was, however, 2.3 visits. If more patients had responded to the SMSS feedback to contact the hospital (see chapter 5), the difference in number of visits would have been even smaller as these patients would probably have had to come to the hospital for further investigation. Other studies have also reported that reductions in regular care using eHealth were lower than expected [38, 48]. The hesitance of healthcare professionals to use eHealth equipment is suggested as an important factor contributing to the results falling short of expectation [38], which corresponds to the seemingly limited acceptance of the SMSS by the healthcare professionals during the RCT.
Patient’s adherence to a self-monitoring protocol
Adherence to a measurement protocol is important for all patients who engage in self-monitoring, but especially for kidney transplant patients. As most patients who develop graft rejection are asymptomatic and present with an increased serum creatinine only, frequent measuring is essential to make the difference between treatment in time and damage to or even loss of the kidney transplant. Based on data that was derived from the RCT, we concluded in chapter 6 that level of adherence to self-monitoring creatinine was generally good. Well above 90% of all patients performed the requested number of measurements during month 2-4 after transplantation. Adherence was somewhat lower during the first month (75%) when a high measurement frequency was requested, and at the longer term during months 5-12 after transplantation (85%). 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[49, 50]. For self-monitoring blood pressure, patients with uncontrolled hypertension were shown to be adherent for about 73% of the entire study period[51, 52]. In both studies, level of adherence was highest in the first few weeks and declined gradually over time. The level of adherence that has been found in the current study therefore 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
General discussion 163
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