@Article{信息:doi 10.2196 / / jmir。6932，作者=“McInnes, D Keith和Shimada, Stephanie L和Midboe, Amanda M和Nazi, Kim M和Zhao, Shibei和Wu, Justina和Garvey, Casey M和Houston, Thomas K”，标题=“患者使用电子处方补充和安全消息及其与无法检测到的HIV病毒载量的关系:一项回顾性队列研究”，期刊=“J Med Internet Res”，年=“2017”，月=“2”，日=“15”，卷=“19”，数=“2”，页=“e34”，关键词=“健康记录，个人;艾滋病毒;病毒载量;电子处方;电子邮件;安全信息;自我保健;背景:电子个人健康记录(PHRs)可以支持患者对慢性疾病的自我管理。通过接受抗逆转录病毒治疗(ART)管理人体免疫缺陷病毒(HIV)病毒载量对艾滋病毒感染者的长期生存至关重要。 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. Objective: The 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. Methods: We 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. Results: Among 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. Conclusions: PHR 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. ", issn="1438-8871", doi="10.2196/jmir.6932", url="//www.mybigtv.com/2017/2/e34/", url="https://doi.org/10.2196/jmir.6932", url="http://www.ncbi.nlm.nih.gov/pubmed/28202428" }