gms | German Medical Science

Background: Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth applications could be a chance to support patients taking their medications as prescribed.

Research question and objective: The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with mood disorders.

Method: A systematic search was performed according to the PICO scheme across the following databases: PubMed, Cochranelibrary, Web of Science and PsycInfo. Studies in English or German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool.

Results: A total of 17 articles were included in this review. 3 were controlled clinical trials, 11 randomized controlled trials and 3 had a pre-/post-design. 3 different types of interventions could be identified: multi-faceted intervention addressing different dimensions of medication adherence (n=4), single-faceted interventions (n=9) comprising 4 mobile interventions and 5 telehealth interventions. 11 interventions addressed patients with (comorbid) depressions, 6 patients with bipolar disorders. 6 interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts.

Discussion: All included eHealth interventions for enhancing medication adherence in patients with affective disorders are at least as effective as control conditions (mostly usual care). However, considering additional benefits of eHealth interventions, like reduced costs of healthcare provision, improved access, or reduced hospitalization rates, eHealth medication adherence programs seems to be suitable to address rural or underserved populations. Despite the fact, that interventional studies in patients with bipolar disorders are challenging, due to low prevalence rates and impaired ability of patients to remember and perform tasks, eHealth intervention on medication adherence seems to be effective for patients with depression as well as with bipolar disorders. Most of the studies could not find statistically significant results. That might be due to the fact that studies on eHealth interventions for improving medication adherences face some methodological challenges (e.g. blinding, complexity of the healthcare setting, social bias, Hawthorne effect, etc.). Personal contact seems to improve the effectiveness of eHealth interventions.

Practical implications: eHealth interventions are an effective way to improve medication adherence in patients with different affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access and preventing high hospitalization rates.

Appeal for science: More analyses are needed in order to understand positive and negative determinants for the effectiveness of eHealth interventions on medication adherence enhancement.