Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.
Stanford School of Medicine, Stanford University, Stanford, California, USA.
J Am Med Inform Assoc. 2019 Aug 1;26(8-9):696-702. doi: 10.1093/jamia/ocz024.
To examine sociodemographic characteristics associated with use of My HealtheVet (MHV) by veterans living with HIV.
Veterans Health Administration administrative data were used to identify a cohort of veterans living with HIV in fiscal years 2011-2017. Descriptive analyses were conducted to examine demographic characteristics and racial/ethnic differences in MHV registration and tool use. Chi-Square tests were performed to assess associations between race/ethnicity and MHV registration and tool use.
The highest proportion of registrants were non-Hispanic White veterans living with HIV (59%), followed by Hispanic/Latino (55%) and Black veterans living with HIV (40%). Chi-Square analyses revealed that: (1) MHV account registration was significantly lower for both Black and Hispanic/Latino veterans in comparison to White veterans and (2) Black MHV registrants were less likely to utilize any MHV tool compared with White MHV registrants including Blue Button record download, medication refills, secure messaging, lab, and appointment views.
In line with prior research on personal health record (PHR) use among non-veteran populations, these findings show racial and ethnic inequities in MHV use among veterans living with HIV. Racial and ethnic minorities may be less likely to use PHRs for a myriad of reasons, including PHR privacy concerns, decreased educational attainment, and limited access to the internet.
This is the first study to examine racial and ethnic disparities in use of MHV tools by veterans living with HIV and utilizing Veterans Health Administration health care. Future research should examine potential moderating factors linked to decreased PHR use among racial and ethnic minority veterans, which could inform strategies to increase PHR use among vulnerable populations.
调查与使用 My HealtheVet(MHV)相关的社会人口学特征,这些患者为患有 HIV 的退伍军人。
利用退伍军人事务部行政数据,在 2011-2017 财年确定了一组患有 HIV 的退伍军人队列。进行描述性分析,以检查 MHV 注册和工具使用的人口统计学特征和种族/族裔差异。采用卡方检验评估种族/族裔与 MHV 注册和工具使用之间的关联。
登记注册人数最多的是患有 HIV 的非西班牙裔白人退伍军人(59%),其次是西班牙裔/拉丁裔(55%)和患有 HIV 的黑人退伍军人(40%)。卡方分析显示:(1)与白人退伍军人相比,黑人和西班牙裔/拉丁裔退伍军人的 MHV 账户注册率明显较低;(2)与白人 MHV 注册者相比,黑人和西班牙裔/拉丁裔退伍军人使用任何 MHV 工具的可能性均较低,包括 Blue Button 记录下载、药物续配、安全消息、实验室和预约查看。
与针对非退伍军人人群的个人健康记录(PHR)使用的先前研究一致,这些发现表明 HIV 患者中,退伍军人 MHV 使用存在种族和民族差异。少数民族和族裔可能由于多种原因不太可能使用 PHR,包括 PHR 隐私问题、教育程度降低以及互联网接入有限。
这是第一项研究,调查了 HIV 患者中使用 MHV 工具的种族和民族差异,并利用退伍军人事务部医疗保健。未来的研究应研究与少数民族退伍军人 PHR 使用减少相关的潜在调节因素,这可以为弱势群体的 PHR 使用提供信息。