Discussion
To our knowledge, this systematic review and meta-analysis is the first to systematically assess the influence of eHealth interventions in improving medication adherence to patient with KTx. 9 eligible studies were identified, and our meta-analysis included data from 4 studies. This systematic review included only RCTs with a high level of evidence among interventional studies. Our findings suggest that eHealth can improve medication compliance and decreased rejection in kidney transplant patients in the short term as well as guidance regarding the development of eHealth interventions. Data were sparse for most other outcomes. We believe that more trials are needed to determine the clinical outcomes of eHealth interventions on transplant kidney function, rejection, and Patient-centered patient outcomes report (eg, patient satisfaction).
Previous studies, though, have provided a systematic review of compliance interventions in the kidney transplant population,But a result with only a descriptive analysis and no quantitative synthesis can affect the effectiveness of the results (28 ). Additionally, another meta-analysis included studies that showed compliance interventions improved medication compliance in KTx (29 ), but more reported non-eHealth interventions, such as behavioral and cognitive interventions or medication knowledge improvement. Recently, some meta-analyses on medication compliance in solid organ transplantation have been published. Shi et al. (10 ) performed subgroup analysis according to organ type and found that compliance intervention could improve medication compliance with KTx. The meta-analysis of Lee et al. (17 ) on solid organ transplantation including kidney transplantation showed that the results of eHealth intervention were similar to that of routine care intervention. The effect of eHealth intervention on medication compliance in kidney transplant patients is not clear. This highlights the importance of this study.
Our review used different models of eHealth intervention. For example, some studies only used mobile apps, while others used electronic medication dispenser, a consumer-centred video, or comprehensive intervention (e.g., electronic medication dispenser and physician notification). In addition, optimal type, frequency and duration of electronic intervention are unclear. Further research is needed in the later stage.
KTx remains the gold standard for the treatment of most ERSD. Due to limited resources for health care expenditure, Long-term survival of transplanted kidneys is important for patient health and public health resources. The long-term effects and economic benefits of eHealth interventions for KTx are unclear. In our study, the longest follow-up time after intervention was 12 months and the shortest was only 3 months. Due to the short duration of follow-up, this highlights the need for long-term follow-up in the future.
This review found few articles examined patient satisfaction and preferences for particular types of eHealth interventions. Three studies (19 , 22 , 23 ) assessed patient satisfaction, and most patients were satisfied with the electronic devices used in eHealth interventions. Satisfaction may indirectly affect patient utilization. Other studies did not report patient satisfaction. But the use of electronic devices was reported. Han et al. (24 ) shown over one-half of the patients stopped using the Adhere4U application within the first month, and only 10% of the remaining patients were using the app up to the end of the study. Low et al. research (26 ) showed 42% of patients underutilized Medication Event Monitoring System during the 12-month intervention. A high attrition rate might have lowered the overall size of the effect of intervention(low). The results on satisfaction are inconclusive. There is need for more studies to evaluate user satisfaction with eHealth interventions targeted at improving medication adherence to kidney transplant patient.