Page 170 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

168
Chapter 7
been consulted. More extensive qualitative research during the development of the SMSS and ADMIRE logistic protocol may have guaranteed that concerns could be addressed earlier, for example by also listening carefully to physicians that were more critical of self-monitoring.
Study design
Third, a traditional randomized controlled trial (RCT) design may not have been the best choice in the current situation. According to Van der Meijden and colleagues[66], the evaluation of eHealth is often aimed at measuring the effects of the eHealth intervention while the value of evaluations to improve a technology during development and implementation is neglected. Unlike in evaluating drugs, users’ opinions of or reactions to computer systems decide whether or not a system will have an effect[67]. It is needed to understand what differences eHealth technologies can make in healthcare, why eHealth technologies make these differences, and why eHealth technologies may not have the expected impact[68]. To answer these questions, it is important to take the conditions for implementation into account right from the start, by performing formative evaluations to test design assumptions and prototypes throughout the entire process [69]. We used process variables (i.e. number of logons to the SMSS, number of outpatient visits) as a proxy for acceptance, but we did not gather more in-depth information about why the current eHealth technology worked very well for patients but did not succeed in gaining an optimal effect. For example, if we had taken a more practical approach and performed formative evaluations during the RCT, we would have observed that less outpatient appointments were replaced than anticipated. By discussing these findings openly with both healthcare professionals and patients we could have tried to figure out the reasons for not scheduling telephonic instead of outpatient appointments and, if possible, have made changes to the protocol accordingly to optimize the possible effectiveness. The advantage of such a flexible approach is that one can deliver a protocol that has shown to be ‘the best practice’ (within the boundaries of available time and money) instead of having to stick to the more rigid procedures that are concomitant to an RCT.
General conclusion
Self-monitoring kidney function after transplantation is highly appreciated by patients and can improve the detection of complications while leading to a reduction in healthcare consumption at the same time. To increase the potential of self-monitoring kidney function to replace part of standard outpatient care, it is recommended to use accurate measurement devices and design the protocol with the help of a multidisciplinary and representative project group. For future eHealth-related studies, it