Nursing Department, Dover Park Hospice, Singapore.
Nursing Department, National Neuroscience Institute, Singapore.
Int J Nurs Stud. 2021 Oct;122:104037. doi: 10.1016/j.ijnurstu.2021.104037. Epub 2021 Jul 15.
Asthma is a common chronic condition amongst children. Poor adherence to asthma medications can increase asthma exacerbations, absence from school, healthcare utilisation and costs and decrease quality of life. Emerging evidence suggests the use of electronic adherence monitoring devices in improving children's adherence to medications.
This study aimed to evaluate the effectiveness of electronic adherence monitoring devices in improving inhaler adherence amongst children with asthma.
This study is a systematic review and meta-analysis.
A systematic search using Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus and ProQuest Dissertations and Theses from inception up to April 6, 2021, was conducted.
Randomised controlled trials evaluating the use of electronic adherence monitoring devices amongst children and published in English were included. The outcomes were inhaler adherence, asthma exacerbation, lung function, asthma control and accessibility. The overall effect was measured using Hedges' g and determined using Z-statistics at a significance level of p < 0.05. Heterogeneity was assessed using χ and I² statistics. The individual and overall quality of evidence was assessed. Sensitivity and subgroup analyses were conducted. Narrative synthesis of outcomes was performed when meta-analysis could not be conducted on the data.
A total of 13,429 records were identified, and 10 randomised controlled trials in 11 articles amongst 1123 participants were included in the meta-analysis. Meta-analysis revealed that the electronic adherence monitoring device group was 1.50 times more likely to adhere to inhalers compared with the control group with medium-to-large effect size (g = 0.64). A series of subgroup analyses showed that no significant subgroup differences for inhaler adherence were found amongst different populations, comparator, setting, duration of the monitoring period, reminder, and feedback functions of the electronic adherence monitoring devices. Children found the devices as user friendly with high accessibility scores. However, no significant differences were observed between the intervention and control groups for asthma exacerbations, lung function and asthma control.
The findings from this study suggested that electronic adherence monitoring devices could improve inhaler adherence. Future devices should contain actuation and inhalation functions that can help to confirm actual inhalation amongst children with asthma. The overall evidence of outcomes ranged from very low to high. Furthermore, future large-scale trials were recommended before clinical implementations.
哮喘是儿童常见的慢性疾病。哮喘药物治疗依从性差会增加哮喘恶化、缺课、医疗保健利用和成本，并降低生活质量。新出现的证据表明，使用电子药物依从性监测设备可以提高儿童对药物的依从性。
本研究旨在评估电子药物依从性监测设备在提高哮喘儿童吸入器依从性方面的有效性。
这是一项系统评价和荟萃分析。
系统检索了 Cochrane 图书馆、PubMed、Embase、CINAHL、Web of Science、Scopus 和 ProQuest Dissertations and Theses，从建库到 2021 年 4 月 6 日，均纳入评估电子药物依从性监测设备在儿童中应用的随机对照试验，并以英文发表。结果包括吸入器依从性、哮喘恶化、肺功能、哮喘控制和可及性。使用 Hedges'g 测量总体效果，并使用 Z 统计量在 p < 0.05 的显著性水平上确定。使用 χ 和 I² 统计量评估异质性。评估个体和总体证据质量。进行敏感性和亚组分析。当无法对数据进行荟萃分析时，采用叙述性综合方法进行结果分析。
共检索到 13429 条记录，纳入 11 篇文章中的 10 项随机对照试验，共 1123 名参与者。荟萃分析显示，电子药物依从性监测设备组与对照组相比，更有可能坚持使用吸入器，具有中到大的效果量（g=0.64）。一系列亚组分析表明，在不同人群、对照、环境、监测期持续时间、提醒和电子药物依从性监测设备反馈功能方面，吸入器依从性无显著亚组差异。儿童认为该设备用户友好，可及性得分高。然而，干预组和对照组在哮喘恶化、肺功能和哮喘控制方面没有观察到显著差异。
本研究结果表明，电子药物依从性监测设备可以提高吸入器的依从性。未来的设备应包含动作和吸入功能，以帮助确认哮喘儿童的实际吸入。各项结局的总体证据质量从极低到高不等。此外，建议在临床实施前进行大规模的临床试验。
