The impact of e-Health interventions on promoting Self-Care in Chronic Patients. An Umbrella Review

Background: Promoting self-care is one of the most promising strategies to manage people with chronic conditions and to improve the Public Health System resilience. In this context, the use of e-Health could facilitate self-care promotion, assure continuity of care and save time. Methods: We performed an umbrella review on Cochrane, Scopus, Medline, PsychInfo, CINAHL to analyse e-Health self-care promoting intervention in patients with Type- 2 Diabetes Mellitus (T2DM), Cardiovascular Diseases (CVD) and Chronic Obstructive Pulmonary Disease (COPD) compared to traditional intervention. AMSTAR-2 was used for quality appraisal. Results: 10 systematic reviews were included for an amount of 376 RCTs and 3 quasi-experimental studies. All the e-Health interventions retrieved were categorized in 4 subgroups: Phone Reminder, Telemonitoring, Psychoeducational intervention supported by PCs/Apps and Combined Intervention. Nurses (271/379 studies) and physicians (149/379 studies) were the healthcare workers mostly involved in the administration of eHealth interventions. T2DM (5 reviews; 175 studies) and CVD (7 reviews; 164 studies) patients gained more progresses in selfmanagement than COPD patients (3 reviews; 8 studies). EHealth appeared effective both in promoting self-management and disease awareness. Globally, all the e-Health interventions seemed to improve Quality of Life and clinical outcomes. Phone reminders were most effective to increase Medication Adherence. All Causes Mortality registered a positive effect through Telemonitoring. Hospital Admission and CostEfficacy were explored only by telemonitoring and it did not show differeces with traditional intervention. Conclusions: E-Health is an effective strategy to promote self-care in patients with chronic conditions and to improve quality of life and clinical outcomes. Further research is required to test eHealth intervention in COPD patients and to examine if there is different efficacy among e-Health subgroups.