Page 34 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 2
Patients’ satisfaction
Patients reported high levels of satisfaction with the self-monitoring facilities of the DMS (baseline M=7.25, SD=1.23) which significantly increased over time (follow-up M=7.78, SD=1.19, p=.01) A high level of satisfaction at follow-up was related to higher levels of trust in the accuracy of the creatinine meter (p<.01), perceived autonomy supportiveness of physicians (p<.01) and self-efficacy concerning self-monitoring skills (p<.01).
The most important perceived advantage of self-monitoring at follow-up was the receipt of an automatic warning in case creatinine level was increased (table 4 and table 3, quote 5). In general, patients tended to agree with the list of suggested advantages, whereas they tended to disagree with the list of suggested disadvantages (table 4). Slight changes were observed in the ratings of advantages and disadvantages over time (table 4). For example, the advantage that physicians had access to the values measured at home was rated as less advantageous at follow-up than at baseline (p=.01).
Patients’ adherence to measurement protocol
Level of adherence to measurement protocol is depicted in figure 2. As number of registered creatinine and blood pressure values was similar within patients, adherence rates pertain to both creatinine and blood pressure measurements. Mean adherence was consistently close to or greater than 100% (i.e. more measurements than requested were registered). However, there were large differences between patients that increased over time. Adherence ranged from 0 to 367% during the follow-up period in week 10-12, with 4 patients recording less than 80% and 14 patients recording more than 120% of the required measurements. None of the patient characteristics was related to measurement adherence. We hypothesized that either patients’ kidney function (i.e. eGFR according to the MDRD formula using laboratory serum creatinine) or the amount of variation in successive measurements might be related to how frequent patients measured their creatinine and blood pressure. Additional analyses showed that kidney function was not related to measurement frequency (p .33). However, between measurement frequency and mean variation in successive measurements a trend was observed (p .08), suggesting a higher amount of variation to be related to lower measurement frequency and vice versa.