RESUMEN
Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.
RESUMEN
Objective: To assess factors influencing Veterans' decisions to initiate physical therapy (PT) after referral for low back pain (LBP) or knee osteoarthritis (OA). Design: Qualitative study using individual semistructured telephone interviews. Setting: Durham Veterans Health Administration Health Care System. Participants: A total of 44 Veteran patients (N=44) aged 26-85 were referred for LBP or knee OA between January and August 2021. Results: Patient-level factors influencing PT initiation included confusion with navigating the health system, efficacy beliefs about PT, and thoughts about physical therapists' ability to diagnose their pain. At the provider level, discussion about PT care appeared to increase initiation of PT. At the system level, influences included wait times, availability of appointments outside business hours, and easy-to-access locations. Motivational themes included respondents' symptoms and functional limitations that drove them to initiate care. Respondents suggested that changes to wait times through same-day or rapid appointments, assistance and increased ease of the scheduling process, transportation support, convenient care locations, and information about PT, including its benefits, could improve PT care access. Conclusions: This study of patient perceptions of initiating PT care after referral identified tangible barriers to care at patient, provider, and system levels for respondents with LBP or knee OA. Patient knowledge and system-level barriers, including how challenging the system is to navigate, are major factors that reduce patients' use of PT after referral. Health systems and physical therapists should address barriers to care through patient education, scheduling assistance, and changes to the health care system, including options for same-day appointments.
RESUMEN
Measuring "home time," number of days not in facility-based care, with medical claims is a promising approach to assess person-centered outcomes on a population level. Generally, spending more time at home matches long-term care preferences and improves quality of life. However, existing "home time" measures have not incorporated key stakeholder perspectives. We sought to understand how patients and family caregivers value time spent in diverse facility-based health care settings (Emergency Department, Nursing Home, Post-Acute Care/Skilled Nursing, Inpatient Hospital) to help determine whether various settings have different effects on quality of life and thus merit different weighting in a "home time" measure. We conducted three focus groups among patients and family caregivers within the U.S. Veterans Health Care System. We identified themes pertaining to patients' quality of life in each of the four facility-based care settings. Discussions about both emergency department and post-acute/skilled nursing care reflected loss of personal control, counterbalanced by temporary stay. Inpatient hospital care evoked discussion about greater loss of personal control due to the intensity of care. Nursing homes ultimately signified decline. These findings illuminate differences in quality of life across health-care settings and help justify the need for different weights in a measure of "home time."
