ABSTRACT
INTRODUCTION: Electronic adherence monitoring (EAM) is increasingly used to improve adherence. However, there is limited evidence on the effect of EAM in across chronic conditions and on patient acceptability. We aimed to assess the effect of EAM on adherence and clinical outcomes, across all ages and all chronic conditions, and examine acceptability in this systematic review and meta-analysis. METHODS: A systematic search of Ovid MEDLINE, EMBASE, Social Work Abstracts, PsycINFO, International Pharmaceutical Abstracts and CINAHL databases was performed from database inception to December 31, 2020. Randomised controlled trials (RCTs) that evaluated the effect of EAM on medication adherence as part of an adherence intervention in chronic conditions were included. Study characteristics, differences in adherence and clinical outcomes between intervention and control were extracted from each study. Estimates were pooled using random-effects meta-analysis, and presented as mean differences, standardised mean differences (SMD) or risk ratios depending on the data. Differences by study-level characteristics were estimated using subgroup meta-analysis to identify intervention characteristics associated with improved adherence. Effects on adherence and clinical outcomes which could not be meta-analysed, and patient acceptability, were synthesised narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed, and Risk of bias (RoB) assessed using the Cochrane Collaboration's RoB tool for RCTs. The review is registered with PROSPERO CRD42017084231. FINDINGS: Our search identified 365 studies, of which 47 studies involving 6194 patients were included. Data from 27 studies (n = 2584) were extracted for the adherence outcome. The intervention group (n = 1267) had significantly better adherence compared to control (n = 1317), (SMD = 0.93, CI:0.69 to 1.17, p<0.0001) with high heterogeneity across studies (I2 = 86%). There was a significant difference in effect according to intervention complexity (p = 0.01); EAM only improved adherence when used with a reminder and/or health provider support. Clinical outcomes were measured in 38/47 (81%) of studies; of these data from 14 studies were included in a meta-analysis of clinical outcomes for HIV, hypertension and asthma. In total, 13/47 (28%) studies assessed acceptability; patient perceptions were mixed. INTERPRETATION: Patients receiving an EAM intervention had significantly better adherence than those who did not, but improved adherence did not consistently translate into clinical benefits. Acceptability data were mixed. Further research measuring effects on clinical outcomes and patient acceptability are needed.
Subject(s)
Asthma , Asthma/drug therapy , Bias , Chronic Disease , Electronics , Humans , Medication AdherenceABSTRACT
As the world focuses on containing the spread of the coronavirus disease 2019 (COVID-19) and limiting the effects of the pandemic on the global population, care must be taken not to lose sight of existing individual health issues. There is a real risk of creating a 'post-pandemic double burden of disease'- where the pressures of having to manage acute COVID-19-related impacts on the health system are added to the existing burden of chronic non-communicable diseases or long-term conditions in developed countries. This could create a post-pandemic health crisis by devoting less attention to existing health conditions. A growing evidence base from other epidemics and health emergencies highlight the potential negative impact of short-term health crises on long-term public health. The significant disruptions to the usual healthcare systems and society can lead to increased morbidity and mortality in the long-term if not managed appropriately. This viewpoint provides an overview of the evidence to support the management of long-term conditions during, and after, health emergencies, to limit the impact of COVID-19 on public health in the short- and long-term.