Page 167 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

Timely registration of measurements
To make optimal use of the feedback system that was incorporated into the SMSS, measurement results had to be registered as soon as possible after the measurement was performed. Many patients, however, saved up their measurements over several days or even weeks to register them all at once (chapter 6). This probably occurred because logging on to the SMSS took time and registering multiple measurements at once was therefore considered more efficient. However, when measurements are registered retrospectively, the advice given by the SMSS is no longer up to date. One can imagine patients saving up measurements in case of a stable creatinine trend, but patients seemed to have postponed registration regardless of the stability of their kidney function. 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. Postponed registration appeared to be the main reason why patients had not followed up the advices that were generated by the SMSS. For example, the advice to contact the hospital (which only appeared when creatinine had increased by >15%) was given 24 and followed 14 times (58%). In the remaining 10 cases (concerning 10 individual patients) measurements were registered with several days delay. If only cases with registration on the day of measurement were taken into account, adherence to contacting the hospital was 100%. Postponed registration of measurements will no longer be an issue in case a device is used that can automatically transfer data, combined with a system that can send the automatic feedback to a patients’ mobile phone directly.
Clinical implications and directions for future research
The results as described in this thesis show that self-monitoring kidney function after transplantation seems attractive to kidney transplant patients and can lead to a significant decrease in number of outpatient visits without compromising on quality of care. Further, self-monitoring offers a convenient solution to increase monitoring frequency, which could probably lead to earlier detection and treatment of complications and, consequently, improved clinical outcomes. However, the results as described in this thesis also indicate there is some room for improvement. For example, although the readiness of kidney transplant patients to self-monitor was high considering the high response rate in both the pilot study and randomized controlled trial, a few patients quit their participation voluntarily. The main reason for quitting was because of problems related to the creatinine device. Further, some patients indicated they experienced too little benefit of self-monitoring creatinine post- transplantation. The fact that the reduction in number of outpatient visits was smaller than expected might have contributed to the limited benefit these patients experienced. Summarizing, self-
General discussion 165
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