Effects of eHealth Interventions on improving medication adherence in
kidney Transplant Recipients: A Systematic Review and Meta-analysis of
Randomized Controlled Trials
Abstract
Aims Immunosuppressant non-adherence is a prevalent problem leading to
many adverse outcomes in Renal transplant recipients. eHealth has the
potential to improve medication compliance, but evidence in kidney
transplantation remains unclear. This review aims to explore the effects
of eHealth interventions on improving medication compliance in Kidney
transplantation. Methods A systematic search was conducted of the
following databases: PubMed, Embase, Cochrane Library, CINAHL, and Web
of Science Core Collection. The search included studies published up to
July 22, 2021. Two authors selected relevant studies and extracted data
independently. The quality of the literature was evaluated using the
Cochrane collaborative bias risk tool. 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. Results Nine studies involving 777 patients were included.
Compared with control group, eHealth interventions improved medication
adherence measured by electronic monitoring (RR=1.46, 95%CI, 1.11 to
1.90, p=0.006) and decreased rejection (RR=0.38; 95%CI, 0.15 to 0.97,
p=0.04). There was no difference in medication compliance measured by
BAASIS (RR=1.03, 95% CI, 0.88 to 1.21, p=0.72), Tacrolimus level
(MD=0.16, 95%CI, -0.21 to 0.52, p=0.39), coefficient of variation of
tacrolimus level (MD=-0.01, 95%CI, -0.05 to 0.02, p=0.41), and kidney
function (MD=-0.44, 95% CI, -8.32 to 7.43, p=0.91) between the two
groups. Conclusions eHealth interventions can improve medication
adherence in kidney transplantation in the short time. However more
high-quality intervention studies need performing to determine whether
eHealth improves long-term adherence and clinically relevant outcomes.