Transplant Trial Watch

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

Lee, H., et al.

PLoS ONE [Electronic Resource] 2020; 15(11): e0241857.

The aim of this study was to determine whether eHealth interventions were more effective in improving medication adherence in organ transplant recipients compared to usual or conventional care alone.

Electronic databases such as MEDLINE via Pubmed, CINAHL, the Cochrane Register Controlled Trials, PsycINFO, EMBASE and six domestic Korean databases were searched. Study selection and data extraction were carried out independently by two reviewers. The Cochrane risk of bias tool was used to assess the quality of individual studies.

7 studies were included in the review.

The outcomes were the assessment of medication adherence and medication knowledge.


CET Conclusions
This is a well conducted systematic review of RCTs in eHealth interventions. EHealth interventions include digital adjuncts such as mobile phone applications, web-based education, automated reminders and monitoring. A protocol was pre-emptively registered and the review conducted in accordance with PRISMA guidelines. Multiple databases with wide coverage were searched, and in duplicate, although data was not extracted in duplicate. A risk of bias assessment was performed using the Cochrane Risk of Bias guidance. Meta-analysis was conducted for the 5 studies that provided an objective assessment of medication adherence. These still had a significant level of heterogeneity (I-squared=50%) and the overall Risk Ratio suggested that eHealth interventions had no significant benefit for medication adherence compared to standard care. The only study that showed a significant effect was one that involved the physician directly contacting the patient if the monitoring system (wireless pill bottle) suggested that their compliance had dropped below 90%. The overview differs from experience of eHealth interventions in asthma and cardiovascular disease, but the reason for this is not explored by this review.

Trial registration
PROSPERO - CRD42017067145

Funding source
Non-industry funded