Page 168 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 7
monitoring is well accepted among patients and has the potential to improve health care after kidney transplantation. To further increase the potential of self-monitoring kidney function after transplantation to replace part of regular outpatient care, we suggest that the following three points need careful consideration.
The accuracy of measurement devices
The use of a creatinine device that is less accurate than what both healthcare professionals and patients are used to may have played an important role in the limited reduction of outpatient visits. As a transplanted kidney is a valuable asset, it is understandable that both healthcare professionals and patients are careful when considering new methods of monitoring kidney function. Patients could turn to the SMSS for interpretation of their creatinine value, but many patients saved up their measurements over several days before registering them online. This suggests that patients interpreted their measurements themselves before registering them in the SMSS. However, the fluctuations in level of self-measured creatinine (even in relatively stable situation) made it difficult for patients to put a single value in the correct perspective, which may have hampered their trust in the creatinine device.
Although we had shown that the self-monitored creatinine values can be used for trend-analysis, using the creatinine device may have clashed with what healthcare professionals perceive to be their professional responsibility. It has been concluded before that for doctors to feel (more) confident about sharing control with their patients, the biomedical aspects of care need to be well addressed [37]. This is an important prerequisite to create doctors’ support for new interventions. If we had used a creatinine device with a more continuous level of accuracy, doctors would probably have felt more at ease with replacing outpatient visits with a telephonic consult. Dried blood spot analysis may offer an alternative to patients self-monitoring creatinine in case reduction of outpatient visits is the main objective, as dried blood spots have been shown to give reliable creatinine results[59, 60]. However, with dried blood spot analyses there is a delay between blood drawing and test results of at least two days, as the dried blood spots first have to be sent to a laboratory before they can be analysed and linked back to the patient. This is not a problem when a regular outpatient visit is being replaced and the patients’ condition is stable, but hampers direct treatment if this is necessary. Moreover, dried blood spot analysis becomes cumbersome in case an increased monitoring frequency is required. And finally, using dried blood spot analyses does not seem to increase patient involvement and autonomy regarding their own treatment. Patients perform the blood collection themselves, but are usually dependent upon the laboratory and their doctor for analysis and interpretation. In conclusion,