Effectiveness of IT-based interventions on self-management in adult kidney transplant recipients: a systematic review

Abstract

Background Kidney transplant outcomes are broadly associated with transplant recipients’ capacity in following a complex and continuous self-management regimen. Health information technology has the potential to empower patients. This systematic review aimed to determine the impacts of IT-based interventions for self-management in kidney transplant recipients. Methods A comprehensive investigation was performed in MEDLINE (via PubMed) and EMBASE (via Scopus) in April 2019. Eligible studies were the randomized controlled trials which aimed to design an automated IT-based intervention. All English papers including adult kidney transplant recipients were included. To assess the clinical trial’s quality, Cochrane Collaboration’s assessment tool was employed. The articles were integrated based on category of outcomes, characteristics of interventions, and their impact. The interventions were classified based on the used IT-based tools, including smart phones, coverage tools, computer systems, and a combination of several tools. The impact of interventions was defined as: (1) positive effect (i.e. statistically significant), and (2) no effect (i.e. not statistically significant). Results A total of 2392 articles were retrieved and eight publications were included for full-text analysis. Interventions include those involving the use of computerized systems (3 studies), smart phone application (3 studies), and multiple components (2 studies). The studies evaluated 30 outcomes in total, including 24 care process and 6 clinical outcomes. In 18 (80%) out of 30 outcomes, interventions had a statistically significant positive effect, 66% in process and 33% in clinical outcomes. Conclusions IT-based interventions (e.g. mobile health applications, wearable devices, and computer systems) can improve self-management in kidney transplant recipients (including clinical and care process outcomes). However, further evaluation studies are required to quantify the impact of IT-based self-management interventions on short- and long-term clinical outcomes as well as health care costs and patients' quality of life.

Pragmatic solutions to enhance self-management skills in solid organ transplant patients: systematic review and thematic analysis

“…Among IT-based solutions, e-health programs or telemedicine-based interventions are more effective than other solutions. Our results are consistent with previous studies that examined the positive effect of IT-based interventions on transplantation in specific organ transplantations [71,73]. Our investigation showed that non-electronic educational resources should be used alongside other IT-based interventions to promote patient self-care to be more effective and applicable.…”

“…Most studies (72.5%) showed that developed programs and applied solutions had a statistically significant positive impact on the ability of transplanted patients to his/her self-management. In the same way, there is a growing body of evidence regarding the positive results of self-management programs in chronic diseases to enhance a person's ability to cope with his/her situation and better management of his/her disease [6,40,71].…”

Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant

“…Such multidisciplinary work has been previously recommended [ 39 ]. Alternative strategies have included digital intervention which has shown some promising improvements in self-management [ 45 ], however, adolescent, and young adult kidney transplantation groups require further investigation [ 46 , 47 ].…”

Assessment of the Effectiveness of Patient Education and Interviews in Improving Medication Adherence of Renal Transplant Recipients

“…This drug training should start from the pre-transplant period and continue in the long term postoperatively. The training aims to eliminate patients' lack of knowledge, correct their mistakes, help them adapt to the post-disease process, and help them comprehend the key points [22][23][24]. Moors-Tielen et al (2008) report that 40% of kidney transplant patients stated that forgetting to take their immunosuppressive drugs would not cause serious problems.…”