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

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. eHealth is a promising tool for addressing poor compliance. OBJECTIVE This review investigates the effects of eHealth interventions on adherence to medication treatment in patients with COPD or asthma and adherence to exercise regimens by patients with COPD. METHODS A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase. We selected randomized controlled trials, conducted on adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention in terms of medication adherence or exercise behavior (for COPD), or medication adherence only (for asthma). Risk of bias in the included studies was examined using the Cochrane Collaboration’s risk-of-bias tool. RESULTS Thirteen studies focusing on COPD, and seven focusing on asthma, were analyzed. Of the COPD studies, five targeted medication adherence, seven targeted exercise adherence, and one examined both. Adherence was a primary outcome in four studies and a secondary outcome in nine. As to medication adherence, two studies reported non-significant effects of the eHealth interventions, one study found a significant improvement, and three reported mixed effects. Regarding exercise adherence, four studies reported no significant effects of the eHealth interventions, three found significant improvements, and one found mixed results. Of the seven studies focusing on medication adherence in asthma, three found significant effects, two reported non-significant effects, and two reported mixed effects. Across all studies, 12 were standalone interventions, whereas eight were added to care as usual. Most studies used care as usual as a control group, whereas a small number of studies used a face-to-face intervention provided by a healthcare professional or waitlist control condition. 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 potentials of eHealth to optimize treatment adherence in COPD and asthma.