Page 24 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

22 Chapter 2
ABSTRACT
After a kidney transplantation, patients have to visit the hospital very often to monitor early signs of graft rejection. Self-monitoring of creatinine in addition to blood pressure at home could alleviate the burden of frequent outpatient visits, but only if patients are willing to self-monitor and if they adhere to the self- monitoring measurement regimen. A prospective pilot study was conducted to assess patients’ experiences and satisfaction.
During three months after transplantation 30 patients registered self-measured creatinine and blood pressure values in an online record to which their physician had access too. Patients completed a questionnaire at baseline and follow-up to assess satisfaction, attitude, self-efficacy regarding self- monitoring, worries, and physician support. Adherence was studied by comparing number of registered with number of requested measurements.
Patients were highly motivated to self-monitor kidney function and reported high levels of general satisfaction. Level of satisfaction was positively related to perceived support from physicians (p<.01), level of self-efficacy (p<.01) and amount of trust in the accuracy of the creatinine meter (p<.01). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite level 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 being related to lower levels of trust. Protocol adherence was generally very high, although the range of adherence levels was large and increased over time.
Patients’ high levels of satisfaction suggest that at home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. Important prerequisites for a safe implementation in transplant care seem to be support from physicians and patients’ confidence in both their own self- monitoring skills and the accuracy of the devices used.