Patient Portal to Support Treatment Adherence

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DESCRIPTION (provided by applicant): Development and implementation of health information technology (HIT) to improve healthcare is a national priority. Web-based shared patient and provider access to electronic medical records (EMR) has the potential of pushing the boundaries of traditional communication and patient care and becoming an essential tool in disease management. Due to the relative newness of this HIT, little is known about the use or application of EMR web portals for individual disease management. Disease management is important in any chronic illness but particularly in HIV, where 20-50% of patients have inadequate adherence to life prolonging antiretroviral therapy (ART). The Information-Motivation-Behavioral Skills (IMB) model suggests that ART adherence is influenced by the extent to which HIV+ patients are well-informed, motivated, and possess skills to act effectively. Use of a web portal that provides patients access to their medical information and a secure way to directly communicate with providers may provide unique opportunities to increase adherence-related information, motivation and behavioral skills. We are seeking to characterize the use of an EMR patient web portal by HIV+ patients, and to design and field test an individual behavioral intervention using this HIT and guided by IMB theory. Our team is in a unique position to conduct this research in two large affiliated health systems (Group Health Cooperative and Kaiser Permanente, Northern California) who have already adopted this new technology into clinical care. The project will be conducted in three related stages over five years. Stage 1 is an observational study using automated data among HIV+ patients to describe EMR web portal use patterns over time and the characteristics of frequent, infrequent and non-users of the web portal. Stage 2 is a randomized pilot with 30 HIV+ persons to examine acceptability/ feasibility issues and refine procedures and measures. In Stage 2, procedures for the nurse-facilitated individual adherence intervention delivered via EMR patient web portal (n=20) and the attention control arm (patient web portal enrollment and informational contacts; n=10) planned for Stage 3 will be piloted. Stage 3 is an RCT of an IMB-based individual intervention delivered by nurses via EMR patient web portal (N=150) as compared to an attention control arm (N=150). Primary outcomes will be ART adherence as measured by automated pharmacy records and self report at post-intervention, 3- and 9-month follow-up. Hypothesized adherence-related IMB intervention change process variables (adherence-related information, motivation, and behavioral skills) will be assessed over time and tested for mediating effects on ART adherence. Secondary outcomes also include 12-month EMR patient web portal utilization and in-person service utilization. This work will enhance our understanding of how patients use EMR patient web portals and highlight the complexities involved in delivering care via this system. It will allow us to evaluate the effectiveness of using HIT as an intervention delivery vehicle to improve patient treatment outcomes, which has relevance beyond HIV disease management. PUBLIC HEALTH RELEVANCE Web-based shared patient and provider access to electronic medical records (EMR) has the potential of pushing the boundaries of traditional communication and patient care and becoming an essential tool in chronic disease management. This project will enhance our understanding of how HIV+ patients use web access to an EMR, and test the effectiveness of such a system as an intervention delivery tool to improve patient outcomes such as medication adherence. Findings from this research will have relevance beyond HIV care to the management of many other chronic diseases.