The Use and Effects of Electronic Health Tools for Patient Self-Monitoring and Reporting of Outcomes Following Medication Use: Systematic Review

Karla Lancaster, Aseel Abuzour, Manmeet Khaira, Annalise Mathers, April Chan, Vivian Bui, Annie Lok, Lehana Thabane, Lisa Dolovich, Karla Lancaster, Aseel Abuzour, Manmeet Khaira, Annalise Mathers, April Chan, Vivian Bui, Annie Lok, Lehana Thabane, Lisa Dolovich

Abstract

Background: Electronic health (eHealth) tools are becoming increasingly popular for helping patients' self-manage chronic conditions. Little research, however, has examined the effect of patients using eHealth tools to self-report their medication management and use. Similarly, there is little evidence showing how eHealth tools might prompt patients and health care providers to make appropriate changes to medication use.

Objective: The objective of this systematic review was to determine the impact of patients' use of eHealth tools on self-reporting adverse effects and symptoms that promote changes to medication use. Related secondary outcomes were also evaluated.

Methods: MEDLINE, EMBASE, and CINAHL were searched from January 1, 2000, to April 25, 2018. Reference lists of relevant systematic reviews and included articles from the literature search were also screened to identify relevant studies. Title, abstract, and full-text review as well as data extraction and risk of bias assessment were performed independently by 2 reviewers. Due to high heterogeneity, results were not meta-analyzed and instead presented as a narrative synthesis.

Results: A total of 14 studies, including 13 randomized controlled trials (RCTs) and 1 open-label intervention, were included, from which 11 unique eHealth tools were identified. In addition, 14 RCTs found statistically significant increases in positive medication changes as a result of using eHealth tools, as did the single open-label study. Moreover, 8 RCTs found improvement in patient symptoms following eHealth tool use, especially in adolescent asthma patients. Furthermore, 3 RCTs showed that eHealth tools might improve patient self-efficacy and self-management of chronic disease. Little or no evidence was found to support the effectiveness of eHealth tools at improving medication recommendations and reconciliation by clinicians, medication-use behavior, health service utilization, adverse effects, quality of life, or patient satisfaction. eHealth tools with multifaceted functionalities and those allowing direct patient-provider communication may be more effective at improving patient self-management and self-efficacy.

Conclusions: Evidence suggests that the use of eHealth tools may improve patient symptoms and lead to medication changes. Patients generally found eHealth tools useful in improving communication with health care providers. Moreover, health-related outcomes among frequent eHealth tool users improved in comparison with individuals who did not use eHealth tools frequently. Implementation issues such as poor patient engagement and poor clinician workflow integration were identified. More high-quality research is needed to explore how eHealth tools can be used to effectively manage use of medications to improve medication management and patient outcomes.

Keywords: adverse effects; drug monitoring; eHealth; electronic health record; mHealth; patient portals; patient-centered care; self-report; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Karla Lancaster, Aseel Abuzour, Manmeet Khaira, Annalise Mathers, April Chan, Vivian Bui, Annie Lok, Lehana Thabane, Lisa Dolovich. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.12.2018.

Figures

Figure 1
Figure 1
Use of the PICO model in this systematic review. eHealth: electronic health.
Figure 2
Figure 2
Preferred Reporting Items for Systematic Reviews and Meta-Analyses style study inclusion flowchart. eHealth: electronic health.
Figure 3
Figure 3
Summary chart of risk of bias assessment for included studies. Risk of bias summary: Green "+" symbols indicate a low risk of bias, yellow "?" symbols indicate an unknown risk of bias, and red "-" symbols indicate a high risk of bias.

References

    1. World Bank. [2017-07-27]. Individuals using the Internet (% of population) .
    1. The Broadband Commission for Digital Development UNESCO. [2017-07-28]. The state of broadband 2015: broadband as a foundation for sustainable development .
    1. Caligtan CA, Dykes PC. Electronic health records and personal health records. Semin Oncol Nurs. 2011 Aug;27(3):218–28. doi: 10.1016/j.soncn.2011.04.007.
    1. Government Of Canada. 2010. Aug 09, [2017-08-10]. eHealth .
    1. Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. J Am Med Inform Assoc. 2011;18(4):515–22. doi: 10.1136/amiajnl-2011-000105.
    1. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc. 2006;13(2):121–6. doi: 10.1197/jamia.M2025.
    1. Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res. 2011;13(3):e65. doi: 10.2196/jmir.1874.
    1. de Lusignan S, Mold F, Sheikh A, Majeed A, Wyatt JC, Quinn T, Cavill M, Gronlund TA, Franco C, Chauhan U, Blakey H, Kataria N, Barker F, Ellis B, Koczan P, Arvanitis TN, McCarthy M, Jones S, Rafi I. Patients' online access to their electronic health records and linked online services: a systematic interpretative review. Br Med J Open. 2014;4(9):e006021. doi: 10.1136/bmjopen-2014-006021.
    1. Hordern A, Georgiou A, Whetton S, Prgomet M. Consumer e-health: an overview of research evidence and implications for future policy. Health Inf Manag. 2011;40(2):6–14.
    1. Dean BB, Lam J, Natoli JL, Butler Q, Aguilar D, Nordyke RJ. Review: use of electronic medical records for health outcomes research: a literature review. Med Care Res Rev. 2009 Dec;66(6):611–38. doi: 10.1177/1077558709332440.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009 Aug 18;151(4):264–9.
    1. Garets D, Davis M. HIMSS Analytics Database. Chicago, IL: HIMMS Analytics; 2006. Jan 26, [2017-08-25]. Electronic medical records vs electronic health records: yes, there is a difference. A HIMSS Analytics white paper .
    1. Upsalla Monitoring Centre. 2017. Feb 13, [2017-08-24]. Common concepts and terms in pharmacovigilance .
    1. Barlow J. How to use education as an intervention in osteoarthritis. Best Pract Res Clin Rheumatol. 2001 Oct;15(4):545–58. doi: 10.1053/berh.2001.0172.
    1. Wood R, Bandura A. Impact of conceptions of ability on self-regulatory mechanisms and complex decision making. J Pers Soc Psychol. 1989 Mar;56(3):407–15. doi: 10.1037/0022-3514.56.3.407.
    1. Canadian Patient Safety Institute. 2016. [2018-10-31]. Medication Reconciliation (MedRec) .
    1. Council of Europe World Health Organization. 2006. Oct 05, [2018-10-31]. Glossary of terms related to patient and medication safety .
    1. Agency for Healthcare Research Quality. Rockville, MD: Agency for Healthcare Research Quality; 2014. Jan, [2018-10-31]. Methods Guide for Effectiveness and Comparative Effectiveness Reviews .
    1. Cho J, Chang S, Kwon H, Choi Y, Ko S, Moon S, Yoo S, Song K, Son H, Kim H, Lee W, Cha B, Son H, Yoon K. Long-term effect of the internet-based glucose monitoring system on HbA1c reduction and glucose stability: a 30-month follow-up study for diabetes management with a ubiquitous medical care system. Diabetes Care. 2006 Dec;29(12):2625–31. doi: 10.2337/dc05-2371.
    1. Chrischilles EA, Hourcade JP, Doucette W, Eichmann D, Gryzlak B, Lorentzen R, Wright K, Letuchy E, Mueller M, Farris K, Levy B. Personal health records: a randomized trial of effects on elder medication safety. J Am Med Inform Assoc. 2014;21(4):679–86. doi: 10.1136/amiajnl-2013-002284.
    1. Fiks AG, Mayne SL, Karavite DJ, Suh A, O'Hara R, Localio AR, Ross M, Grundmeier RW. Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT. Pediatrics. 2015 Apr;135(4):e965–73. doi: 10.1542/peds.2014-3167.
    1. Grant RW, Wald JS, Schnipper JL, Gandhi TK, Poon EG, Orav EJ, Williams DH, Volk LA, Middleton B. Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2008 Sep 8;168(16):1776–82. doi: 10.1001/archinte.168.16.1776.
    1. Gustafson D, Wise M, Bhattacharya A, Pulvermacher A, Shanovich K, Phillips B, Lehman E, Chinchilli V, Hawkins R, Kim JS. The effects of combining Web-based eHealth with telephone nurse case management for pediatric asthma control: a randomized controlled trial. J Med Internet Res. 2012 Jul 26;14(4):e101. doi: 10.2196/jmir.1964.
    1. Joseph CL, Peterson E, Havstad S, Johnson CC, Hoerauf S, Stringer S, Gibson-Scipio W, Ownby DR, Elston-Lafata J, Pallonen U, Strecher V, Asthma in Adolescents Research Team A web-based, tailored asthma management program for urban African-American high school students. Am J Respir Crit Care Med. 2007 May 01;175(9):888–95. doi: 10.1164/rccm.200608-1244OC.
    1. Joseph CL, Ownby DR, Havstad SL, Saltzgaber J, Considine S, Johnson D, Peterson E, Alexander G, Lu M, Gibson-Scipio W, Johnson CC, Research team members Evaluation of a web-based asthma management intervention program for urban teenagers: reaching the hard to reach. J Adolesc Health. 2013 Apr;52(4):419–26. doi: 10.1016/j.jadohealth.2012.07.009.
    1. Schnipper JL, Gandhi TK, Wald JS, Grant RW, Poon EG, Volk LA, Businger A, Williams DH, Siteman E, Buckel L, Middleton B. Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial. J Am Med Inform Assoc. 2012;19(5):728–34. doi: 10.1136/amiajnl-2011-000723.
    1. Simon GE, Ralston JD, Savarino J, Pabiniak C, Wentzel C, Operskalski BH. Randomized trial of depression follow-up care by online messaging. J Gen Intern Med. 2011 Jul;26(7):698–704. doi: 10.1007/s11606-011-1679-8.
    1. Weingart SN, Carbo A, Tess A, Chiappetta L, Tutkus S, Morway L, Toth M, Davis RB, Phillips RS, Bates DW. Using a patient internet portal to prevent adverse drug events: a randomized, controlled trial. J Patient Saf. 2013 Sep;9(3):169–75. doi: 10.1097/PTS.0b013e31829e4b95.
    1. Mooney KH, Beck SL, Wong B, Dunson W, Wujcik D, Whisenant M, Donaldson G. Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT. Cancer Med. 2017 Dec;6(3):537–46. doi: 10.1002/cam4.1002. doi: 10.1002/cam4.1002.
    1. Ahmed S, Ernst P, Bartlett S, Valois M, Zaihra T, Paré G, Grad R, Eilayyan O, Perreault R, Tamblyn R. The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial. J Med Internet Res. 2016;18(12):e313. doi: 10.2196/jmir.5866.
    1. Karhula T, Vuorinen A, Rääpysjärvi K, Pakanen M, Itkonen P, Tepponen M, Junno UM, Jokinen T, van Gils M, Lähteenmäki J, Kohtamäki K, Saranummi N. Telemonitoring and mobile phone-based health coaching among Finnish diabetic and heart disease patients: randomized controlled trial. J Med Internet Res. 2015 Jun 17;17(6):e153. doi: 10.2196/jmir.4059.
    1. Carlsen K, Houen G, Jakobsen C, Kallemose T, Paerregaard A, Riis LB, Munkholm P, Wewer V. Individualized infliximab treatment guided by patient-managed eHealth in children and adolescents with inflammatory bowel disease. Inflamm Bowel Dis. 2017 Dec;23(9):1473–82. doi: 10.1097/MIB.0000000000001170.
    1. Eland-de KP, van Os-Medendorp H, Vergouwe-Meijer A, Bruijnzeel-Koomen C, Ros W. A systematic review of the effects of e-health on chronically ill patients. J Clin Nurs. 2011 Nov;20(21-22):2997–3010. doi: 10.1111/j.1365-2702.2011.03743.x.
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986 Jan;24(1):67–74.
    1. Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc. 2007 Oct;55(Suppl 2):S373–82. doi: 10.1111/j.1532-5415.2007.01345.x.
    1. MacLean CH, Pencharz JN, Saag KG. Quality indicators for the care of osteoarthritis in vulnerable elders. J Am Geriatr Soc. 2007 Oct;55(Suppl 2):S383–91. doi: 10.1111/j.1532-5415.2007.01346.x.
    1. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005 Dec;40(6 Pt 1):1918–30. doi: 10.1111/j.1475-6773.2005.00438.x.
    1. Bukstein DA, McGrath MM, Buchner DA, Landgraf J, Goss TF. Evaluation of a short form for measuring health-related quality of life among pediatric asthma patients. J Allergy Clin Immunol. 2000 Feb;105(2 Pt 1):245–51. doi: 10.1016/S0091-6749(00)90072-1}.
    1. Zorc JJ, Pawlowski NA, Allen JL, Bryant-Stephens T, Winston M, Angsuco C, Shea JA. Development and validation of an instrument to measure asthma symptom control in children. J Asthma. 2006 Dec;43(10):753–8. doi: 10.1080/02770900601031615.
    1. Gustafson DH, Hawkins R, Pingree S, McTavish F, Arora NK, Mendenhall J, Cella DF, Serlin RC, Apantaku FM, Stewart J, Salner A. Effect of computer support on younger women with breast cancer. J Gen Intern Med. 2001 Jul;16(7):435–45.
    1. Juniper EF, O'Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999 Oct;14(4):902–7.
    1. Wise M, Gustafson DH, Sorkness CA, Molfenter T, Staresinic A, Meis T, Hawkins RP, Shanovich KK, Walker NP. Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a Web-based asthma education program. Health Promot Pract. 2007 Jul;8(3):282–91. doi: 10.1177/1524839906289983.
    1. Bloom B, Cohen RA, Freeman G. Summary health statistics for US children: National Health Interview Survey, 2009. Vital Health Stat 10. 2010 Dec;(247):1–82.
    1. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. US Department of Health and Human Services, National Institutes of Health National Heart, Lung, and Blood Institute. 2007. [2017-07-28]. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007 .
    1. Weiland SK, Björkstén B, Brunekreef B, Cookson WO, von Mutius E, Strachan DP, International Study of AsthmaAllergies in Childhood Phase II Study Group Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods. Eur Respir J. 2004 Sep;24(3):406–12. doi: 10.1183/09031936.04.00090303.
    1. Croft DR, Peterson MW. An evaluation of the quality and contents of asthma education on the World Wide Web. Chest. 2002 Apr;121(4):1301–7. doi: 10.1378/chest.121.4.1301.
    1. National Asthma Education and Prevention Program . National Heart, Lung, and Blood Institute. Hyattsville, MD: U.S. Department of Health and Human Services; 1997. [2017-07-28]. Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma .
    1. Lucas CP, Zhang H, Fisher PW, Shaffer D, Regier DA, Narrow WE, Bourdon K, Dulcan MK, Canino G, Rubio-Stipec M, Lahey BB, Friman P. The DISC Predictive Scales (DPS): efficiently screening for diagnoses. J Am Acad Child Adolesc Psychiatry. 2001 Apr;40(4):443–9. doi: 10.1097/00004583-200104000-00013.
    1. Dahlem NW, Zimet GD, Walker RR. The multidimensional scale of perceived social support: a confirmation study. J Clin Psychol. 1991 Nov;47(6):756–61.
    1. Derogatis Lr, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. In: Pichot P, Olivier-Martin R, editors. Psychological measurements in psychopharmacology. Oxford, England: Karger; 1974. pp. 79–110.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606–13.
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. J Am Med Assoc. 1999 Nov 10;282(18):1737–44.
    1. National Patient Safety Foundation. 2017. [2017-07-28]. For Patients and Families .
    1. Ross SE, Lin C. The effects of promoting patient access to medical records: a review. J Am Med Inform Assoc. 2003 Apr;10(2):129–38.
    1. Ammenwerth E, Schnell-Inderst P, Hoerbst A. The impact of electronic patient portals on patient care: a systematic review of controlled trials. J Med Internet Res. 2012;14(6):e162. doi: 10.2196/jmir.2238.
    1. Cotter AP, Durant N, Agne AA, Cherrington AL. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence. J Diabetes Complications. 2014;28(2):243–51. doi: 10.1016/j.jdiacomp.2013.07.003.
    1. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res. 2010;12(2):e23. doi: 10.2196/jmir.1286.
    1. Kaelber D, Pan EC. The value of personal health record (PHR) systems. AMIA Annu Symp Proc. 2008:343–7.
    1. Pham Q, Wiljer D, Cafazzo JA. Beyond the randomized controlled trial: a review of alternatives in mHealth clinical trial methods. JMIR Mhealth Uhealth. 2016 Sep 09;4(3):e107. doi: 10.2196/mhealth.5720.
    1. Linn A, Vervloet M, van Dijk L, Smit EG, Van Weert JC. Effects of eHealth interventions on medication adherence: a systematic review of the literature. J Med Internet Res. 2011 Dec 05;13(4):e103. doi: 10.2196/jmir.1738.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera