Effectiveness of eHealth interventions for improving medication adherence of organ transplant patients: A systematic review and meta-analysis

Abstract

Background: Organ transplantation is the most effective treatment for patients with end-stage organ failure. It has been actively carried out all over the world. Recently, eHealth interventions have been applied to organ transplant patients. This systematic review and meta-analysis aimed to evaluate the effects of eHealth interventions for improving medication adherence in organ transplant patients as compared to usual or conventional care alone.

Methods: We searched MEDLINE via PubMed, Excerpta Media dataBASE (EMBASE), the Cochrane Register Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and six domestic Korean databases to identify randomized controlled trials (RCTs) published up to April 17, 2020. Two reviewers independently selected relevant studies and extracted data. The quality and bias of the identified studies were assessed. To estimate the effect size, a meta-analysis of the studies was performed using the Cochrane Collaboration software Review Manager 5.3. PRISMA guidelines were followed. When statistical heterogeneity was greater than 80%, narrative synthesis was performed.

Results: Of the 1,847 articles identified, seven RCTs with a total of 759 participants met the inclusion criteria. The risk of bias assessment showed that the blinding of participants and personnel was high. In six studies, medication adherence (effect size = -0.18-1.30) and knowledge scores were not significantly different between those receiving eHealth interventions and the controls.

Conclusions: Our findings suggest that eHealth interventions were similar to standard care or advanced care for improving medication adherence, and they faired equally well for improving medication knowledge. Therefore, eHealth interventions can be used for medication adherence of organ transplant patients. More research is needed to provide well-designed eHealth intervention to improve the medication adherence and knowledge of organ transplant patients.

Protocol registration number: CRD42017067145 16/05/2017.

Fig 1. Flowchart of the RCT selection process.

Fig 2. Risk of bias summary.

Fig 3. Forest plot of the pooled effect size of eHealth interventions for medication adherence in organ transplant patients.

The five studies presented here used objective methods to measure medication adherence in organ transplant patients and presented the results as dichotomous data.

Fig 4. Forest plot without a pooled estimate demonstrating the effectiveness of eHealth interventions for medication adherence in organ transplant patients.

The two studies presented here used objective methods to measure medication adherence in organ transplant patients and presented the results as continuous data.

Fig 5. Forest plot without a pooled estimate demonstrating the effectiveness of eHealth interventions for medication adherence in organ transplant patients.

The four studies presented here used subjective methods to measure medication adherence in organ transplant patients and presented the results as dichotomous data.

Fig 6. Forest plot without a pooled estimate demonstrating the effectiveness of an eHealth intervention for medication adherence in organ transplant patients.

The one study presented here used subjective methods to measure medication adherence in organ transplant patients and presented the results as continuous data.