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2015 HSR&D/QUERI National Conference Abstract

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1092 — Veteran Use of Electronic Prescription Refill and its Association with Control of HIV

McInnes DK, Center for Healthcare Organization and Implementation Research, HHQUERI; eHealth QUERI; Boston University School of Public Health; Houston TH, Center for Healthcare Organization and Implementation Research, eHealth QUERI; UMASS Medical School; Boston University School of Public Health; Midboe AM, VA Palo Alto; Ci2i; HHQUERI; Shimada SL, Center for Healthcare Organization and Implementation Research, eHealth QUERI; UMASS Medical School; Boston University School of Public Health; Zhou S, Center for Healthcare Organization and Implementation Research;

Objectives:
Electronic personal health records (PHRs) are expanding in availability and provide useful tools to manage health (communication, transactions, etc.). We sought to examine whether Veterans with HIV, who need considerable ongoing connection to healthcare systems, benefit from the VA's My HealtheVet (MHV) PHR.

Methods:
Using My HealtheVet data linked to CDW, we examined 3289 HIV+ Veterans who had uncontrolled HIV viral load (also known as "detectable viral load") in 2009 and who continued to receive VHA care in 2012. We examined patterns of MHV use and viral load status over time.

Results:
Even beyond HIV status, most of the sample consisted of vulnerable Veterans according to several metrics: 62% were African American, 46% were poor, 60% had depressive symptoms, and 41% had a substance use disorder. Of the 3289 who had a detectable HIV viral load in 2009, 2,196 of them (66.8%) had become undetectable by 2012, while 1093 (33.2%) still had a detectable viral load. In our multivariable model examining use of MHV's electronic prescription refill ("Rx refill"), there was a positive association between use of Rx refill and viral load control. Veteran using Rx refill had 1.36 the odds (95% CI 1.11-1.66) of having controlled viral load compared to Veterans who did not use Rx refill, after adjusting for socio-demographic and health variables. In addition, older age and being white were independently and positively associated with viral load control, while being poor (borderline significant) and having psychoses were associated with reduced likelihood of viral load control.

Implications:
Use of online prescription refill through a PHR may facilitate improved medication adherence and chronic disease control for Veterans with HIV. This is particularly promising because adherence to HIV medications remains a major challenge for management of that condition.

Impacts:
PHRs may provide an important means for some Veterans to improve their adherence to chronic disease medications and achieve improved health. More work is needed to understand how to tailor PHR tools so that increased numbers of Veterans will use them for chronic disease management.