Page 182 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Summary
The objective of the study that is described in chapter 5, was to investigate whether self-monitoring kidney function supported by an online Self-Management Support System (SMSS), where both patient and doctor had access to, can lead to a reduction in number of outpatient visits in the first year post- transplantation without compromising on quality of care. 119 patients were randomized to the intervention group, with patients self-monitoring creatinine and blood pressure and face to face and telephonic consults being alternated, or the control group, who received standard post- transplantational care. Number of outpatient contacts and clinical outcomes (eGFR, blood pressure, satisfaction and quality of life) were compared between the two groups. For the intervention group specifically, we looked at the extent to which creatinine trends measured at home were comparable to laboratory-based creatinine trends. Further, twenty intervention patients were interviewed on their self-monitoring experiences. The results showed that self-monitoring can lead to a significant decrease in number of outpatient visits (16.02 and 18.35 face to face visits for the intervention and control group, respectively, p .007) without compromising on quality of care, as was indicated by the absence of differences between intervention and control patients for eGFR, blood pressure, quality of life and general satisfaction at one year follow-up. Remarkably, the medical staff poorly adhered to the protocol of replacing physical visits with telephonic consults, leading to an underestimation of the true effect of self-monitoring on number of outpatient visits.
In 78% of relevant creatinine increases (>10%), a similar trend for home-based and laboratory-based measurements was observed, which is 10% higher than what was found in the study reported in chapter 3. Interview data showed that satisfaction was high: 95% of the interviewed patients would recommend self-monitoring to others and 75% would have liked to continue self-monitoring beyond one year. These results led to the conclusion that self-monitoring creatinine after transplantation is highly appreciated by patients and enables the number of outpatient visits to be reduced without having to compromise on quality of care. Improving the implementation of self-monitoring into post- transplantational care is expected to lead to even greater reductions in number of outpatient visits.
Chapter 6 describes a study in which we investigated the level of adherence to the self-monitoring protocol used during the RCT, the reliability of patient-reported test results and whether patients took appropriate actions based on their measurements. Level of adherence to the self-monitoring protocol was generally good, with well above 90% of all patients performing the requested number of measurements during month 2-4 after transplantation. Adherence was lower during the first month and during months 5-12 after transplantation. Approximately 90% of both creatinine and blood