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.