Abstract
BackgroundElectronic personal health records (PHRs) can support patient self-management of chronic conditions. Managing human immunodeficiency virus (HIV) viral load, through taking antiretroviral therapy (ART) is crucial to long term survival of persons with HIV. Many persons with HIV have difficulty adhering to their ART over long periods of time. PHRs contribute to chronic disease self-care and may help persons with HIV remain adherent to ART. Proportionally veterans with HIV are among the most active users of the US Department of Veterans Affairs (VA) PHR, called My HealtheVet. Little is known about whether the use of the PHR is associated with improved HIV outcomes in this population.ObjectiveThe objective of this study was to investigate whether there are associations between the use of PHR tools (electronic prescription refill and secure messaging [SM] with providers) and HIV viral load in US veterans.MethodsWe conducted a retrospective cohort study using data from the VA’s electronic health record (EHR) and the PHR. We identified veterans in VA care from 2009-2012 who had HIV and who used the PHR. We examined which ones had achieved the positive outcome of suppressed HIV viral load, and whether achievement of this outcome was associated with electronic prescription refill or SM. From 18,913 veterans with HIV, there were 3374 who both had a detectable viral load in 2009 and who had had a follow-up viral load test in 2012. To assess relationships between electronic prescription refill and viral control, and SM and viral control, we fit a series of multivariable generalized estimating equation models, accounting for clustering in VA facilities. We adjusted for patient demographic and clinical characteristics associated with portal use. In the initial models, the predictor variables were included in dichotomous format. Subsequently, to evaluate a potential dose-effect, the predictor variables were included as ordinal variables.ResultsAmong our sample of 3374 veterans with HIV who received VA care from 2009-2012, those who had transitioned from detectable HIV viral load in 2009 to undetectable viral load in 2012 tended to be older (P=.004), more likely to be white (P<.001), and less likely to have a substance use disorder, problem alcohol use, or psychosis (P=.006, P=.03, P=.004, respectively). There was a statistically significant positive association between use of electronic prescription refill and change in HIV viral load status from 2009-2012, from detectable to undetectable (OR 1.36, CI 1.11-1.66). There was a similar association between SM use and viral load status, but without achieving statistical significance (OR 1.28, CI 0.89-1.85). Analyses did not demonstrate a dose-response of prescription refill or SM use for change in viral load.ConclusionsPHR use, specifically use of electronic prescription refill, was associated with greater control of HIV. Additional studies are needed to understand the mechanisms by which this may be occurring.
Highlights
Electronic health records (EHRs) are increasingly being adopted by hospitals, health plans, and other health care providers to improve the efficiency and effectiveness of health care delivery, meet provisions of the Affordable Care Act, and to qualify for Meaningful Use financial incentives [1,2,3]
Among our sample of 3374 veterans with human immunodeficiency virus (HIV) who received Veterans Affairs (VA) care from 2009-2012, those who had transitioned from detectable HIV viral load in 2009 to undetectable viral load in 2012 tended to be older (P=.004), more likely to be white (P
There is evidence that secure messaging (SM) may contribute to increased likelihood of achieving chronic illness control, such as diabetes and hypertension, because of improved patient-provider communication [5,6,7]. These personal health record SM (PHR) self-management tools may be especially beneficial for persons with human immunodeficiency virus (HIV) who must carefully adhere to their combination antiretroviral therapy (ART), and often have other chronic conditions that they must manage simultaneously [8]
Summary
Electronic health records (EHRs) are increasingly being adopted by hospitals, health plans, and other health care providers to improve the efficiency and effectiveness of health care delivery, meet provisions of the Affordable Care Act, and to qualify for Meaningful Use financial incentives [1,2,3] Many of these EHRs include personal health records (PHRs, known as “patient portals”), which enable patients to view parts of their medical record such as laboratory results, past and future appointments, and upcoming preventive care. There is evidence that secure messaging (SM) may contribute to increased likelihood of achieving chronic illness control, such as diabetes and hypertension, because of improved patient-provider communication [5,6,7] These PHR self-management tools may be especially beneficial for persons with human immunodeficiency virus (HIV) who must carefully adhere to their combination antiretroviral therapy (ART), and often have other chronic conditions that they must manage simultaneously [8]. Little is known about whether the use of the PHR is associated with improved HIV outcomes in this population
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