User needs in kidney disease monitoring: a user oriented approach to health technology assessment

Introduction: The perspective of the end-user is often overlooked in the evaluation of a technology, especially in the development phase. We aim to extent on an existing model to include the needs & wants of actual users into health technology assessment. Methods: The novel application of the Medimate Multireader® is focused on the monitoring of electrolytes in the blood and is targeted especially at patients at risk of kidney disease. The application should be used by the patient itself. We conducted literature analysis, clinician and patient interviews, and questionnaires to estimate the impact of this technology on the patient, and their willingness and ability to perform self-monitoring tests. Results: First, we identified that patients with diabetes mellitus were the largest and easiest identifiable target group for the device. Second, the clinical needs of the patient group were identified through literature review, practice guideline analysis and interviews with general practitioners and patients. It was concluded that the clinical benefit of this technology to the patient is limited, but there is a desire among patients to have more frequent checks of kidney function. Third, different “use” cases were developed based on the qualitative data collected. In the fourth phase of this study, which is currently ongoing, we use a conjoint analysis methodology to place values on the different aspects of the technology implementation, to determine which factors are most crucial for future development and ultimately implementation. Discussion: The model enables active gearing of the technology towards user needs. As implementation of the technology is crucially dependent on user related factors such as acceptance and actual use, this is paramount. With the addition of quantitative data gathering in the last phase, value judgments are made explicit and further development decisions can be based on data that is easy to interpret for the developer.