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Health Systems Research

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CDA 09-016 – HSR Study

 
CDA 09-016
Understanding Health Information and Informatics Needs of Veterans
Donald K McInnes, ScD MS BA
VA Bedford HealthCare System, Bedford, MA
Bedford, MA
Funding Period: February 2010 - January 2015
BACKGROUND/RATIONALE:
Consumer health informatics such as electronic personal health record (PHR) systems, mobile devices, and the internet, give patients online access to health information and their medical record, and enable transactions such as ordering medication refills. Little is known about how veterans with serious chronic conditions are using the VAs PHR (called My HealtheVet or "MHV") and other health informatics technologies, or whether the use of such systems facilitates chronic disease self-management.

OBJECTIVE(S):
1) Understand the factors associated with Internet and MHV use among veterans, and assess the extent to which such use contributes to HIV-self-management. We will:
a)Assess the association of demographics, health-related attitudes and beliefs, HIV sero-status, and health status with veterans' use of the internet and My HealtheVet for health-related purposes (e.g. gathering information, ordering prescription refills).
b)Assess whether health-related use of the Internet and MHV is associated with patients' HIV self-management, e.g. patient activation, self-efficacy for communication with providers, and adherence to medication and care visits.
2) Explore patient perceptions of internet and MHV use for health-related purposes.
3) Develop and pilot test a prototype care communication intervention to assist HIV+ veterans with disease self-management. A prominent feature of the intervention involves patients sharing their MHV record with an informal caregiver.
4) Prepare a randomized controlled trial of the care communication intervention.

METHODS:
Objective #1: we are conducting a secondary analysis of longitudinal data (n=approximately 6,000 veterans) from an ongoing observational cohort study, the Veterans Aging Cohort Study (VACS). We will use univariate, bivariate, and multi-variate analytical techniques to characterize differences between veterans who use and do not use internet and MHV (objective #1a). We will use multi-variable regression to assess whether internet and MHV use has an independent association with self-efficacy for self-management and adherence to anti-retroviral therapy (using pharmacy refill data and self-report) (objective #1b);

Objective #2: we will use focus groups and semi-structured interviews to evaluate patient and informal caregiver preferences, barriers, and facilitators related to health informatics tools to improve disease self-management. Analysis will use modified grounded theory.

Objective #3: we will develop and pilot test a communication intervention that uses consumer health informatics such as MHV or mobile devices to improve communication between Veterans and their clinicians and/or their informal caregivers. We will use participatory design (i.e. frequent input from Veterans) at different stages of the development.

Objective #4: We will randomize participants to either the intervention plus usual care, or an information brochure plus usual care. We will use self-report and CPRS data to assess self-efficacy for self-management, medication adherence, and retention in care.

FINDINGS/RESULTS:
None at this time

IMPACT:
This project resulted in improved tools and mechanisms for Veterans to engage in the VA health care system and to improve their ability to self-manage chronic health conditions (e.g. treatment adherence, healthy behaviors, retention in VA health care). This improved engagement and continuity of care leads to more appropriate use of health care services (e.g. increases in outpatient care and decreases in emergency department use and inpatient stays). These impacts are designed to target vulnerable groups who in the past were affected by the digital divide, i.e. they were less likely, compared to the general population, to access and use information technologies for health related purposes. Lessons from our text messaging system with vulnerable veterans have been applied to the development of national text messaging services organized by the VA's Office of Connected Health. That system, called "Annie", is in beta-testing in 3 VA hospitals.


External Links for this Project

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PUBLICATIONS:

None at this time.


DRA: Infectious Diseases, Health Systems
DRE: Treatment - Efficacy/Effectiveness Clinical Trial, Technology Development and Assessment
Keywords: none
MeSH Terms: none

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