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Antiretroviral Therapy Adherence and Use of an Electronic Shared Medical Record Among People Living with HIV

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Abstract

Electronic shared medical records (SMR) are emerging healthcare technologies that allow patients to engage in their healthcare by communicating with providers, refilling prescriptions, scheduling appointments, and viewing portions of medical records. We conducted a pre-post cohort study of HIV-positive adults who used and did not use SMR in two integrated healthcare systems. We compared the difference in antiretroviral refill adherence between SMR users and age- and sex-frequency matched non-users from the 12-month period prior to SMR useto the 12-month period starting 6 months after initiation of SMR use. High adherence was maintained among SMR users (change = −0.11 %) but declined among non-users (change = −2.05 %; p = 0.003). Among SMR users, there was a steady improvement in adherence as monthly frequency of SMR use increased (p = 0.009). SMR use, particularly more frequent use, is associated with maintaining high adherence and non-use is associated with declines in adherence over time among patients with access to these online services.

Resumen

Los expedientes médicoselectrónicoscompartidos (EMC) son unanacientetecnología para la salud, quepermite a los pacientesparticipar en suatenciónmédicamediante la comunicación con los proveedores, actualización de recetas, programación de citas, y la visualización de partes de los expedientesmédicos. Se realizóunestudio de cohorte pre-post, en adultos VIH-positivosqueutilizaron y no utilizaron EMC, en dos sistemas de saludintegrados. Se comparó la diferencia en la adherencia de actualizaciónantirretroviral entre los usuarios de SMR y no usuarioscomparables en edad y sexo en el período de 12 meses antes deluso del EMC hasta 12 mesesdespués de transcurridosseismeses del inicio del uso del EMC. Se observóunaaltaadherencia en los usuarios del EMC (cambio = −0.11 %), con unadisminución entre los no usuarios (cambio = −2.05 %, p = 0.003). En los usuariosdel EMC, hubounamejoríasostenida de la adherencia, al aumentar la frecuencia del EMC (p = 0.009). El uso del EMC, particularmentesuusofrecuente, se asocia con el mantenimiento de altaadherencia y el no uso se asocia con la disminución en la adherencia a lo largo del tiempo entre los pacientes con acceso a estosservicios en línea.

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Acknowledgements

The authors would like to thank Christine Mahoney and Courtney G. Ellis for project management, and Steven M. Carzasty, MSW for his key early input regarding study design and analysis. This research was supported by National Institutes of Health grant numbers R01MH081750 and K23MH097649.

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Authors and Affiliations

  1. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Parya Saberi

  2. Group Health Research Institute, Seattle, WA, USA

    Sheryl L. Catz, Christine Stewart, James D. Ralston & Louis Grothaus

  3. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Sheryl L. Catz

  4. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, 94612, CA, USA

    Wendy A. Leyden & Michael J. Silverberg

  5. Mid-Atlantic Permanente Research Institute, Rockville, MD, USA

    Michael A. Horberg

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  1. Parya Saberi
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  2. Sheryl L. Catz
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  3. Wendy A. Leyden
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  4. Christine Stewart
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Correspondence to Michael J. Silverberg.

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Saberi, P., Catz, S.L., Leyden, W.A. et al. Antiretroviral Therapy Adherence and Use of an Electronic Shared Medical Record Among People Living with HIV. AIDS Behav 19 (Suppl 2), 177–185 (2015). https://doi.org/10.1007/s10461-014-0982-x

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