Impact of eHealth on medication adherence among patients with asthma: A systematic review and meta-analysis

Background: Asthma is an important public health issue in the United States. eHealth technology offers a potential solution to asthma treatment adherence, but the relative effect of various types of eHealth interventions has not been systematically studied. Objectives: To systematically review the effectiveness of eHealth in improving adherence to inhaled corticosteroids (ICS) among patients with persistent asthma, as well as the satisfaction of patients undergoing eHealth interventions. Methods: Literature searches were conducted in five databases in August 2018. Included studies were randomized controlled trials comparing eHealth interventions versus usual care in improving adherence among patients prescribed ICS for persistent asthma. Quantitative synthesis was performed using a random effects model. Results: Eighty records were identified after removal of duplicates. Fifteen trials were eligible for qualitative synthesis. Included trials utilized: social media (n=1), electronic health records (n=1), telehealth (n=6), and mHealth (n=7). Twelve trials were eligible for quantitative synthesis. Results show a small but significant overall effect of eHealth interventions on adherence to ICS (Standardized Mean Difference (SMD)=0.41, 95% CI=0.02-0.79). Among the different types of eHealth interventions, a significant improvement in adherence was observed for mHealth interventions compared to usual care in a pooled analysis of 4 trials (SMD=0.96, 95% CI=0.28-1.64). However, there was considerable heterogeneity among studies. Patient satisfaction was evaluated in 5 trials comparing telehealth (n=2) and mHealth (n=3) with usual care. Participants found the interventions to be helpful and satisfactory. Conclusion: eHealth interventions, especially mHealth interventions, are effective and acceptable in improving patient adherence to ICS.