Page 169 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

improving the accuracy of the point of care creatinine device as used in the RCT is desirable for at least two reasons. First, the device can analyse a drop of blood within seconds, accelerating the detection of a deteriorating kidney function and the start of treatment. Second, it enables patients to become full-fledged partners in their own care, as they perform the full cycle of blood drawing, interpretation of test result (whether or not supported by a feedback system) and acting (i.e. contacting their doctor) in case the results give cause for concern.
A multidisciplinary approach in developing and implementing eHealth
A second point that should be taken into account is that the developmental process of the ADMIRE system may not have been optimal. Many eHealth interventions for chronic conditions have been shown to struggle with engaging both patients and healthcare professionals, with low uptake and high dropout rates[42]. It has been stated that many of the approaches that are being used to develop eHealth technologies are not productive enough to create technologies that are meaningful, manageable and sustainable[61]. According to the World Health Organization, a mismatch between context and technology is the main reason why up to three quarters of the implementation of new medical devices fails[62]. This mismatch could be due to the fact that practice can’t keep up with the ongoing technological developments. It takes years to fully implement a new procedure, and by then the ‘new’ procedure will probably be outdated already. However, there are also other factors that can contribute to the mismatch between context and technology. The Normalization Process Theory (NPT) [63] states that for a successful implementation of new health technologies, it is important that there is a (shared and individual) understanding of the benefits of a new technology and a general expectation that the concerning technology makes people’s life or work easier[64]. So, the implementation of new services is expected to run more smoothly if all parties involved see the added value of a new technology. In the ADMIRE project, we especially focused on the experiences of patients with self-monitoring. In cooperation with the technical university of Delft, different studies have been performed in parallel to the RCT to learn more about patients’ acceptance of our SMSS and their preferences for, for example, feedback style[33, 65]. The results of these studies gave us the tools to explain some of our study findings and to give recommendations for implementation to enable future use of SMSSs in kidney transplant patients. However, the opinion of the other group of end users, the healthcare professionals, has probably not been sufficiently taken into account. For example, the first time we found out that the medical staff considered it unrealistic to start replacing face to face visits with telephonic consults directly from discharge after transplantation was during the kick-off meeting of the RCT. This point would probably have come up much earlier if more healthcare professionals had
General discussion 167
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