Use of Electronic Prescription Refills Linked to Veterans’ Improved Health.

In recent years, electronic personal health records (PHRs) have been increasingly adopted by hospitals, health plans, and other providers to improve the effectiveness of health care delivery and encourage patient self-management.

A new study led by a School of Public Health researcher affiliated with the Department of Veterans Affairs (VA) found that veterans with HIV who used electronic prescription refills were more likely to have significant improvements in HIV viral load status (from “detectable” to “undetectable”) over three years than those who did not use the PHR.

Veterans with detectable viral loads in 2009 who used the electronic prescription-refill function between 2010 and 2012 had 1.36 times the likelihood of achieving undetectable viral loads in 2012, according to the study in the Journal of Medical Internet Research. There was a similar association found regarding the use of another PHR function—secure messaging with providers—but it did not reach statistical significance.

“That the use of a PHR electronic prescription-refill feature was positively associated with undetectable viral load status in this vulnerable population is encouraging, in that it may indicate an augmentation of access to medications and providers,” the study says. “The PHR tools … may afford patients a greater sense of freedom to perform functions (such as) ordering refills and communicating with providers … and improve self-efficacy in addressing health-related tasks and challenges.”

The study examined PHR use and viral loads among roughly 3,300 veterans with HIV who had obtained care from the VA between 2010 and 2012. The VA launched its PHR system, called My HealtheVet, in 2003, and enrollment has climbed, with about one-third of veterans currently using it.

The authors noted that the management of HIV is complex, requiring patients to adhere carefully to an antiretroviral regimen. Additionally, many people with HIV have other physical or mental health problems—another reason why they may benefit from more frequent provider-patient communications, the authors said.

“We were pleased to find that using the electronic refill function was associated with improved viral control,” said lead author D. Keith McInnes, research associate professor of health law, policy, and management and researcher at the Center for Healthcare Organization and Implementation Research at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA.

“It’s possible that, for veterans with HIV, the personal health record may provide a sense of privacy and anonymity that encourages their regular medication refills,” he said. “With stigmatized health conditions, providing patients with a variety of options for communication with their health care team may be quite beneficial.”

The researchers acknowledged that the study did not prove a causal relationship between use of the PHR and viral load. They encouraged further study of the potential benefits of electronic prescription refills and other PHR tools.

The study noted that patients diagnosed with psychosis had a higher likelihood of uncontrolled viral loads, indicating that they may need more help adhering to their HIV medications.

Co-authors on the study included Stephanie Shimada, a research assistant professor of health law, policy, and management also affiliated with the Bedford VA. Other co-authors were from: the Center for Innovation to Implementation, VA Palo Alto Health Care System; the Veterans Health Administration; the Department of Quantitative Health Sciences, University of Massachusetts Medical School; and the Bouve College of Health Sciences, Northeastern University.

—Lisa Chedekel