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2015 HSR&D/QUERI National Conference Abstract

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3175 — My HealtheVet: Perspectives of Veterans and their Informal Caregivers

Bolton RE, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; HHQUERI; Solomon JL, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; HHQUERI; Clark JA, Center for Healthcare Organization and Implementation Research; HHQUERI; Boston University School of Public Health; Steinhauser K, Durham VA Medical Center, Duke University School of Medicine; Dieperink E, Department of Psychiatry, Minneapolis Veterans Health Care System; McInnes DK, Center for Healthcare Organization and Implementation Research; HHQUERI; eHealth QUERI; Boston University School of Public Health;

Objectives:
Informal Caregivers (ICs) provide important supports for patients, and virtual care modalities potentially offer new avenues for ICs to assist patients through complex treatment regimes. VA has increasingly recognized the role of ICs, and is considering allowing ICs surrogate access to VA's My HealtheVet (MHV) web-based patient portal. MHV includes features such as secure messaging, medication refilling, and access to the Veteran's medical record. However, ICs do not currently have access, and little is known about IC interest in MHV or whether MHV can facilitate the support ICs provide. This qualitative study examined caregiver support and perspectives of MHV among Veteran-Caregiver dyads undertaking treatment for Hepatitis C.

Methods:
Semi-structured interviews were conducted with a purposive sample of 16 Veteran-caregiver dyads (n = 32) from two VAMCs. Most participants were aged > = 50 and came from blue-collar professions. We asked participants about their perspectives of MHV, and support provision within the dyad. Interview transcripts were inductively coded by two qualitative researchers. Codes were then organized into broader emergent categories using constant comparison.

Results:
Participants reported that ICs provided informational support by seeking out disease and treatment-related information, communicating with providers, and tracking Veterans' appointments, labs, and prescriptions. ICs accomplished these tasks through in-person and phone communication, online searches, spreadsheets to track labs, and electronic and paper calendars/reminders to track appointments and medications. Most Veterans had heard of MHV, yet only a few were actively using MHV to refill medications and track appointments. While many Veterans in this sample expressed inexperience with computers, several noted that their ICs regularly used computers. Despite low current use, most dyads expressed interested in MHV's features and endorsed granting ICs access. ICs also expressed interest in using this technology.

Implications:
There appears to be alignment between the information support activities ICs provide and existing MHV features. Participants were open to granting ICs surrogate access to MHV when policy permits, and saw utility in MHV use to support Veterans.

Impacts:
To successfully implement virtual care modalities, such as MHV, VA should incorporate Veteran and IC perspectives to address their information needs and practices. Trainings for Veterans and ICs to maximize usage should be considered.