Page 180 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Summary
After kidney transplantation, patients have to visit the outpatient clinic frequently to monitor their kidney function. The high frequency of these appointments is burdensome to both the recovering patient and to healthcare resources. Experiences that have been gathered in other conditions requiring chronic care show that self-monitoring important clinical parameters at home has the potential to increase patient satisfaction and accelerate the detection of complications while reducing healthcare consumption at the same time. The general objective of this thesis was to investigate whether self- monitoring kidney function after transplantation supported by an online self-management support system (SMSS) can replace part of regular care safely and without loss of quality of care.
In chapter 2, the results of a prospective pilot study that was performed to investigate kidney transplant patients’ experiences and satisfaction with self-monitoring kidney function after transplantation are described. Thirty patients self-monitored their level of creatinine and blood pressure and registered the measurement results in an online SMSS, where both patients and doctors had access to. The results showed that patients were highly motivated to self-monitor kidney function and reported high levels of general satisfaction. The receipt of an automatic warning when creatinine level was increased was considered the most important benefit of the SMSS. The use of both the creatinine and blood pressure meters was considered pleasant and useful, despite levels of trust in the accuracy of the creatinine device being relatively low. Trust in the accuracy of the creatinine device appeared to be related to level of variation in subsequent measurement results, with more variation accompanying lower levels of trust. Some patients expressed disappointment about their physicians paying little attention to the recorded measurement values. Average adherence to the monitoring protocol was good, but large individual differences between patients were found that increased over time. Based on these findings we concluded that at-home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. However, important prerequisites for a successful implementation of self-monitoring in transplant care seem to be confidence in the accuracy of the devices that are used and patients experiencing support from their physicians.
For the design and implementation of SMSS, it is important to understand the factors that influence patients’ acceptance of such systems. The results of a study in which we aimed to identify these key factors is described in chapter 3. Level of acceptance of the SMSS that was used throughout the randomized controlled trial (RCT, see chapter 5), expressed as behavioural intention to start or continue using the system, was investigated using a self-developed questionnaire based on two models that have been used before to explain people’s acceptance of technology. Fifty kidney