JMIR Publications

ABSTRACT

Background:

Medication nonadherence leads to suboptimal treatment outcomes making it a major priority in healthcare. e-Health provides an opportunity to offer medication adherence interventions with minimal effort from healthcare providers whose time and resources are limited

Objective:

The aim of this systematic review is twofold: 1) to evaluate effectiveness of recently developed and tested e-Health interventions on medication adherence in adult patients using long-term medication, 2) to describe strategies among effective interventions.

Methods:

MEDLINE, EMBASE, Cochrane Library, PsycINFO and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of the identified articles. Eligible studies fulfilled the following inclusion criteria: (1) randomised controlled trial with a usual care control group; (2) applying an interactive e-Health intervention aimed at the patient or patient’s caregiver; (3) medication adherence as primary outcome irrespective of follow-up period; (4) with a total sample of at least 50 adult patients using long-term medication. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies was performed by two researchers independently. A best-evidence synthesis was performed.

Results:

Of the 9,046 records screened, 23 randomised clinical trials were included reporting on 29 interventions. A majority, 17 out of 29 interactive interventions, had a significant positive effect on medication adherence. Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS and/or interactive voice response, mobile applications and calls as mode of providing adherence feedback. Intervention strategies to teach medication management skills, to improve health care quality by coordinating medication adherence care between professionals and to facilitate communication and/or decision making between patients and healthcare providers also showed strong evidence for a positive effect.

Conclusions:

Overall, this review supports the hypothesis that interactive e-Health interventions can be effective in improving medication adherence. Interventions that support behaviour change by improving patient’s treatment involvement and medication management skills are most promising and should be considered for implementation in practice.