Patient experiences with self-monitoring renal function after renal transplantation: results from a single-center prospective pilot study

Abstract

BackgroundAfter a kidney transplantation, patients have to visit the hospital often to monitor for 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.Materials and methodsFor 3 months after transplantation, 30 patients registered self-measured creatinine and blood pressure values in an online record to which their physician had access to. 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 the number of registered with the number of requested measurements.ResultsPatients 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<0.01), level of self-efficacy (P<0.01), and amount of trust in the accuracy of the creatinine meter (P<0.01). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite the 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.ConclusionPatients’ high levels of satisfaction suggest that at-home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. Important prerequisites for 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.

Evaluation of a telehealth solution developed to improve follow‐up after kidney Transplantation

“…Similar challenging conditions for training were found in a study of patients' experiences with training during admission in the early postoperative phase (Urstad, Wahl, Andersen, Øyen, & Fagermoen, 2012). The study identified that emotional, physical and drug-related aspects negatively affected patients' ability to concentrate and learn (Urstad et al, 2012).…”

“…Similar challenging conditions for training were found in a study of patients' experiences with training during admission in the early postoperative phase (Urstad, Wahl, Andersen, Øyen, & Fagermoen, 2012). The study identified that emotional, physical and drug-related aspects negatively affected patients' ability to concentrate and learn (Urstad et al, 2012). They found that the patients found it difficult to apply theoretical knowledge at home, as they had few experiences of transferring knowledge during admission (Urstad et al, 2012).…”

“…The study identified that emotional, physical and drug-related aspects negatively affected patients' ability to concentrate and learn (Urstad et al, 2012). They found that the patients found it difficult to apply theoretical knowledge at home, as they had few experiences of transferring knowledge during admission (Urstad et al, 2012). Training of patients after discharge would be more useful at a time when the physical and emotional postoperative symptoms have settled, and patients have gained experiences of the transfer of health information and knowledge into their everyday lives.…”

Kidney transplant patients’ attitudes towards self-management support: A Q-methodological study

“…For example, a more directive, medical focused support style, typified by the 'Clinician' perspective described by van Hooft et al [26], may be more appropriate to use with patients in profile A. Similarly, a 'Coaching', holistic approach may be more appropriate with patients in profile B. Telemedicine [35] and home-testing of blood pressure and creatinine [36] may be most appreciated by patients in profile D+. We note however that, despite advances in eHealth to support selfmanagement, this patient population unanimously appreciated personal contact with professionals.…”

Psychological perspective of medication adherence in transplantation

“…In a next step, it would be desirable to establish a cognitive and psychosocial rehabilitation plan to improve coping strategies and strengthen the patients’ resources in order to positively influence the final outcome of the transplant process. These efforts therefore must operate simultaneously at several levels on the basis of an integrated strategy that organizes and coordinates the various types of treatment-medication, psychotherapy, assistance-and the operators’ different functions, in an intervention program formulated on the basis of the characteristics and needs of each individual patient[43,44]. …”