Effectiveness of eHealth Interventions in Improving Medication Adherence for Patients With Chronic Obstructive Pulmonary Disease or Asthma: Systematic Review

Abstract

Background Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth. Objective This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma. Methods A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed. Results In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects. Conclusions The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.

Specifications and feasibility of technology-based self-management of COPD: An exploratory qualitative study with patients and providers

“…COPD eHealth interventions of various types and intensity, for example, medication adherence, symptom trackers, educational, and counselling have been developed with mixed results in effectiveness. 14 This research is in line with national self-care strategy 15 that calls for delivery of innovative, personalized, and easy to use self-care programs to build health promotion and disease prevention into practice. Our study highlights a need for a comprehensive easy to use framework that combine interventions that (i) predict/detect an exacerbation episode via monitoring of physiological parameter and contextualizing them with various environmental and personal triggers; (ii) provide feedback in the form of easy-to-understand visualizations that patient can communicate with the PCP during visits; and (iii) use voice activation, graphics, gaming, and information personalization for delivering COPD action plans.…”

Reimbursed medication adherence enhancing interventions in 12 european countries: Current state of the art and future challenges

“…Similarly, there is evidence proving the beneficial role of novel MAEIs, based on eHealth, over medication adherence ( Jeminiwa et al, 2019 ; Aardoom et al, 2020 ). However, not all technology-mediated MAEIs or eHealth interventions are of equal effectiveness ( Mistry et al, 2015 ; Schulte et al, 2021 ). Thus, currently there is still some uncertainty regarding the timing, duration, intensity, and specific types of eHealth-enabled MAEIs that could be most effectively implemented by health care providers.…”

Study protocol for connective tissue disease-associated interstitial lung disease trial (TEL-CTD-ILD): A randomized controlled trial of a home-based telemonitoring of treatment effects

“…The benefit of telemonitoring on detection of pulmonary exacerbations, lung function and quality of life were shown in many studies in chronic lung diseases. Several systematic reviews of telemonitoring in the asthma population concluded that the quality of evidence was inconsistent [ 29 , 30 ]. Still, the benefits of telemonitoring over usual care in the quality of life were reported.…”