Racial and ethnic disparities in use of a personal health record by veterans living with HIV

Abstract

Objective To examine sociodemographic characteristics associated with use of My HealtheVet (MHV) by veterans living with HIV. Materials and Methods 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. Results 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. Discussion 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. Conclusion 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.

Examining multimorbidity differences across racial groups: a network analysis of electronic medical records

“…However, among those who live in poverty and have access to government supplied health insurance, there is a higher use of medical care, and an increased likelihood of diagnosis and likely a lower level of resolving the chronic disease because of the syndemic effects on disease outside of the medicine received for the management of the chronic disease. Furthermore, it is crucial to examine how much the ethnic inequities in the personal health records (PHR) use and digital divide contribute to the comorbidity differences 39 – 41 . Moreover, social stigma has also been related to the health disparities in the past, and therefore this analysis supports the need for targeted interventions to address health related social stigma 42 .…”

Health care utilization and HIV clinical outcomes following Affordable Care Act implementation in California: A longitudinal study

“…It was hoped that disparities would be at least partially mitigated post-ACA [4,37], although recent data indicate that non-whites continue to have worse HIV care outcomes across multiple health care settings [38][39][40]. It is possible that factors associated with race/ethnicity and worse HIV outcomes but not measured in our study, such as health literacy [41] and variability in use of electronic provider communication tools [42,43] could have contributed to these differences. The race/ethnic disparities in HIV clinical outcomes observed in our sample, in which overall insurance coverage was not a barrier to care, highlight the importance of addressing this ongoing challenge to health equity.…”

Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study

“…It was hoped that disparities would be at least partially mitigated post-ACA [ 4 , 38 ], although recent data indicate that Black and Hispanic PWH continue to have worse HIV care outcomes across multiple health care settings [ 39 – 41 ]. It is possible that factors associated with race/ethnicity and worse HIV outcomes not measured in our study such as health literacy [ 42 ] and variability in use of electronic provider communication tools [ 43 , 44 ] could have contributed to these differences. The race/ethnic disparities in HIV clinical outcomes observed in our sample, in which overall insurance coverage was not a barrier to care, highlight the importance of addressing this ongoing challenge to health equity.…”