Abstract
BackgroundChronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients’ self-management skills.ObjectiveThis study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD.MethodsFollowing a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted.ResultsOf the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients’ adherence to interventions.ConclusionseHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.
Highlights
IntroductionChronic kidney disease (CKD) is a major public health concern [1-3]
BackgroundChronic kidney disease (CKD) is a major public health concern [1-3]
Positive effects were found for proximal outcomes, and mixed effects were found for more distal outcomes
Summary
Chronic kidney disease (CKD) is a major public health concern [1-3]. More than 70 million individuals are affected by CKD [4]. CKD is defined as kidney damage or a measured glomerular filtration rate (GFR) of ≤60 mL/min/1.73m2 for more than 3 months. CKD is classified into 5 stages based on GFR decline [5]. The level of kidney function deterioration has a direct relationship with an increase in morbidity and mortality [6], poorer patient outcomes [3], higher hospitalization rates [7], and substantial increase in health care expenditures [8]. Patients with CKD report a lower quality of life (QoL) [9] and may experience severe medical complications and cognitive dysfunction [10]. Chronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Electronic health (eHealth) interventions are increasingly used to optimize patients’ self-management skills
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