The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review (Preprint)

Abstract

BACKGROUND eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE We aimed to assess: 1) use of eHealth in pharmacotherapy management in patients with asthma/chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD), 2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes, and 3) key factors contributing to the success of eHealth interventions for the pharmacotherapy management. METHODS We conducted a scoping review to assess the use and effectiveness of eHealth interventions on medication pharmacotherapy management in asthma/COPD, CVD, and diabetes patients following the PRISMA statement. Databases searched included Embase, MEDLINE, and Cochrane Library. Screening was conducted by two independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared to usual care on pharmacotherapy management or clinical outcomes in patients with asthma/COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al. The effectiveness on pharmacotherapy management outcomes and clinical patient- and clinician-reported outcomes was analysed per type of intervention categorised by number of domains and features to identify trends. RESULTS Of 63 studies included, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma/COPD, CVD, diabetes, or CVD and diabetes, respectively. Most interventions (60%) were targeted at improving medication adherence, often combined to optimize the treatment plan. Six of the asthma/COPD interventions were developed to improve inhaled medication use. Most studies provided an option for feedback to the patient (76%). Most eHealth interventions (32%) combine all three domains of Shaw, followed by 25% combining Interacting for Health with Data Enabling Health. Two-third (42/63) of the studies showed a positive overall effect. Respectively, 48%, 57%, and 39% of the studies reported a positive effect on pharmacotherapy management, clinician-reported clinical, and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes are more often positive in interventions with ≥3 features, but this was not the case for clinician-reported clinical outcomes. There is a trend toward a higher number of studies reporting a positive effect on all three outcomes with an increasing number of domains by Shaw. Of the studies with interventions providing feedback to the patient more studies showed a positive clinical outcome compared to studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma/COPD, CVD, and diabetes. Results suggest feedback is a key factor for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains by Shaw.