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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3064 — Teaching Veterans to Use the Internet and My HealtheVet for Self-Management of Serious Chronic Conditions – A Pilot Study

McInnes DK (VA New England Healthcare System; QUERI HIV/Hepatitis), Solomon JL (VA New England Healthcare System; QUERI HIV/Hepatitis), Shimada SL (VA New England Healthcare System), Bokhour BG (VA New England Healthcare System; QUERI HIV/Hepatitis), Asch SM (VA Greater Los Angeles Healthcare System; QUERI HIV/Hepatitis), Houston TK (VA New England Healthcare System), Nazi KM (Veterans and Consumers Health Informatics Office, VA Office of Health Information), Petrakis BA (VA New England Healthcare System), Gifford AL (VA New England Healthcare System; QUERI HIV/Hepatitis)

Objectives:
Many Americans are using electronic personal health records to stay informed about their health, communicate with healthcare providers, and manage healthcare transactions, such as prescription refills. We evaluate whether training Veterans in Internet and My HealtheVet (MHV) use helps them manage chronic health conditions.

Methods:
Pilot study at 2 urban and 1 rural VA medical centers, of a patient training intervention in use of Internet and MHV for health purposes. The intervention consisted of 4 hands-on group (8 veterans per group) training sessions on an Internet-connected computer. Using individual exercises, paired problem solving, and role-plays we provided skills in Internet searching, evaluating quality of Internet information, refilling prescriptions on MHV, and discussing health information with clinicians. Evaluation involved surveys, semi-structured phone interviews, and ethnographic observation. Outcome measures included disease knowledge, self-efficacy for information seeking and Internet use, and frequency of Internet use.

Results:
The first group comprised of 8 hepatitis C infected Veterans, aged 48-65, low-income, and unstably-housed (5 in homeless shelters or transitional housing). Rudimentary computer skills and difficulty completing the 2-level MHV registration process presented challenges for some participants. The intervention improved Veteran computer attitudes. On a 7-item index of information seeking and Internet use self-efficacy, participants increased an average of 2.2 points, on a 10-point scale (SD = 2.03, p = .02). The convenience of ordering medications through MHV was noted by multiple Veterans. After the training Veterans felt more informed about their health and expressed greater confidence in their interactions with healthcare providers. One reported that bringing information from MHV to the appointment, “…helped the doctor view me as an informed patient”. MHV helped another feel “…a sense of knowing something instead of being totally blank”. Subsequently the training has been expanded to HIV+ Veterans.

Implications:
A group training program helped Veterans gain Internet and MHV skills, feel more confident about interacting with the VA healthcare system and clinicians, and learn to take care of healthcare needs online (e.g. medication refills).

Impacts:
The Internet and MHV provide an opportunity to increase, especially for the most vulnerable Veterans, access to VA healthcare and to health-related information.


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