Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 6, 2025
Open Peer Review Period: Mar 6, 2025 - May 1, 2025
Date Accepted: Apr 24, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of eHealth on medication adherence in kidney transplant recipients: systematic review and meta-analysis
ABSTRACT
Background:
Compared to conventional outpatient or telephone follow-up, the introduction and use of eHealth technologies provide novel opportunities for enhancing medication adherence in transplant recipients. Nonetheless, the efficacy of eHealth treatments regarding medication adherence in kidney transplant recipients remains ambiguous.
Objective:
To assess the impact of eHealth interventions on medication adherence in kidney transplant recipients and to understand the underlying factors.
Methods:
Seven databases (PubMed, Web of Science, Cochrane, Embase, CINAHL, SCOPUS,and OVID) were thoroughly checked from the beginning till November 2024. Each study was assessed for bias using the Cochrane Risk of Bias tool (RoB 2), and the certainty of the evidence for each outcome of interest was rated using the GRADE criteria.The study outcomes were evaluated using a narrative synthesis and a meta-analysis.
Results:
A total of 12 studies involving 897 kidney transplant recipients were included. The eHealth intervention improved medication adherence monitored by electronic devices compared with the control group [RR=1.46, 95% CI (1.11, 1.90)]. However, the differences in adherence to medication as assessed by the Basel Immunosuppressive Medication Adherence Scale [RR=0.98, 95% CI (0.85, 1.13)], tacrolimus blood concentration [MD=0.15, 95% CI (-0.21, 0.51)], and intra-patient variability of tacrolimus [MD=-0.02, 95% CI (-0.07, 0.03)] were not statistically significant. The overall risk of bias was very high or some concerns, and the evidence for all outcomes was of low quality.
Conclusions:
The true effectiveness of eHealth interventions is affected by a variety of confounding factors, and more high-quality future studies are still needed to optimise eHealth intervention strategies and clarify their effectiveness in improving medication adherence. Clinical Trial: PROSPERO CRD42025640638; https://www.crd.york.ac.uk/PROSPERO/myprospero
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