Patient Use of Electronic Prescription Refill and Secure Messaging and Its Association With Undetectable HIV Viral Load: A Retrospective Cohort Study

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.

Pharmacy Customers’ Experiences With Electronic Prescriptions: Cross-Sectional Survey on Nationwide Implementation in Finland

“…A phone number can be added to the request for a text message stating when a renewal has been authorized. Not only is the process convenient and streamlined but the electronic renewal of prescriptions via Web-based portals may also improve patients’ medication adherence and the results of medication therapies [ 20 , 40 , 41 ]. Second, guardians are now entitled to view the ePrescriptions and other health records of their dependents less than 10 years in My Kanta.…”

“…They enable the electronic storing of prescriptions and, as a consequence, streamline the purchasing of medicines at the pharmacy or even online [ 17 ]. Furthermore, electronic storing of medical records has provided patients with access to their personal records via Web-based services, and this has given them a more active role in the management of their medications [ 18 - 20 ]. It is therefore important to study whether patients have sufficient understanding of the system, whether they know how to use the services, and whether the services operate properly [ 21 ].…”

A Systematic Review of Patient-Facing Visualizations of Personal Health Data

“…6,7 The potential benefits of returning health data to the patient include increased comprehension of health status, engagement in care, and adoption of positive health behaviors. [8][9][10] As such, it represents an opportunity for the patient to become a more active participant in their health and wellbeing. Nonetheless, there is reticence to allow patients direct access to their health data without clinician interpretation due to concerns about poor comprehension, risk perception, and possibly dangerous or unhealthy behaviors in response to the data.…”

Secure Messaging Through PositiveLinks: Examination of Electronic Communication in a Clinic-Affiliated Smartphone App for Patients Living with HIV

“…11 HIV patients who use secure messaging have a trend toward higher likelihood of achieving viral suppression. 12 The portal features most valued by patients are patientprovider messaging and access to test results. 13 Provider use of secure messaging is associated with increased patient engagement with electronic portals.…”