A systematic review of the effects of e-health on chronically ill patients.

AIMS AND OBJECTIVES We aimed to investigate whether e-health is equal to or better than usual face-to-face care with regard to outcomes on health, quality of life, patient satisfaction and costs. Therefore, we systematically reviewed the literature on e-health in chronically ill patients compared with or as an addition to usual care. BACKGROUND Interactive websites on internet are increasingly used to inform and treat patients. This type of contact between patients and health care providers, which is called e-health, is easily accessible and particularly interesting for chronically ill patients. DESIGN A systematic review. METHODS We searched the databases PubMed, CINAHL, the Cochrane Database of systematic reviews, DARE and CENTRAL for articles published between January 2000-July 2009. RESULTS The search strategy yielded in total 695 possibly relevant references, which resulted in 12 RCTs after application of the in- and exclusion criteria. Most of the studies were well designed according to the Cochrane criteria for RCTs. The studies are divided into e-health vs. usual care and e-health as addition to usual care. e-Health consisted of monitoring, treatment instructions, self-management training and general information and communication between patient and caregiver. Most of the studies showed small to moderate positive effects on health outcomes. Cost-effectiveness, quality of life and patient satisfaction were rarely investigated in the included studies. CONCLUSIONS e-Health interventions for chronically ill patients, offered instead of usual care or in addition to usual care, lead to small to moderate positive effects on primary health outcomes. However, the evidence was not fully convincing, because of the limited number of studies available and the methodological limitations. Further research is needed to confirm the cost-effectiveness of e-health interventions for patients with chronic diseases. RELEVANCE TO CLINICAL PRACTICE e-Health is a promising tool for treatment and self-management training of chronically ill patients.