How Should We Organize Care for Patients With Human Immunodeficiency Virus and Comorbidities? A Multisite Qualitative Study of Human Immunodeficiency Virus Care in the United States Department of Veterans Affairs

Bokhour, Barbara G.; Bolton, Rendelle E.; Asch, Steven M.; Dvorin, Kelly; Fix, Gemmae M.; Gifford, Allen L.; Hyde, Justeen; McInnes, D. Keith; Richardson, Kelly; Skolnik, Avy A.; Vaughan-Sarrazin, Mary; Wu, Juliet; Ohl, Michael

doi:10.1097/mlr.0000000000001563

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…Similarly, we found clinician participants wanted increased transparency in "ownership" of clinical activities when care is shared between multiple clinicians. Analogous results have been identified by another study conducted among multiple Department of Veterans Affairs Medical Centers; the authors of that study found that for team-based care to be effective, there must be coordination of services [17].…”

Section: Discussionsupporting

confidence: 69%

“…In this transitional period, it is useful to understand patient and clinician preferences for care as well as perceived solutions to care improvement. This is particularly the case for patients struggling to effectively manage their conditions, yet few studies have sought to examine this; those that have, have largely focused on self-management strategies as opposed to care delivery [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Patient and clinician preferences for diabetes management among older adults with co-morbid HIV: A qualitative exploration

Pack,

Masters,

O’Conor

et al. 2024

PLoS ONE

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Background Older adults with HIV are at increased risk of developing certain chronic health conditions including type 2 diabetes mellitus (T2DM). As the number and complexity of conditions increases, so do treatment and health care needs. We explored patient and clinician preferences for HIV+T2DM care and perceived solutions to improving care. Methods We conducted an exploratory qualitative study comprised of individual in-depth interviews. Participants included English-speaking patients aged 50 and older living with HIV and T2DM and infectious disease (ID) and primary care (PC) clinicians from a large academic health center in Chicago. Thematic analysis drew from the Framework Method. Results A total of 19 patient and 10 clinician participants were interviewed. Many patients reported seeking HIV and T2DM care from the same clinician; they valued rapport and a ‘one-stop-shop’. Others reported having separate clinicians; they valued perceived expertise and specialty care. Nearly all clinicians reported comfort screening for T2DM and initiating first line oral therapy; ID clinicians reported placing referrals for newer, complex therapies. Patients would like educational support for T2DM management; clinicians would like to learn more about newer therapies and easier referral processes. Conclusions Patient-centered care includes managing T2DM from a variety of clinical settings for individuals with HIV, yet strategies are needed to better support clinicians. Future research should examine how best to implement these strategies.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Patient and clinician preferences for diabetes management among older adults with co-morbid HIV: A qualitative exploration

Pack,

Masters,

O’Conor

et al. 2024

PLoS ONE

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“…Our data indicated that patients felt supported by IHWC providers in working toward their health goals. As team-based interdisciplinary care is the standard model in the VA for primary and some specialty care (e.g., HIV, chronic pain care), 30 - 34 our findings suggest that interdisciplinary integrative health clinics could be used to help guide patients toward evidence-based and best-practice use of CIH and Whole Health resources in VA. Our findings also indicate the potential effectiveness of such a model to support patients’ holistic health and wellness goals.…”

Section: Discussionmentioning

confidence: 85%

Evaluation of a New Integrative Health and Wellness Clinic for Veterans at the San Francisco VA Health Care System: A Mixed-Methods Pilot Study

Nicosia,

Purcell,

Bertenthal

et al. 2024

Global Advances in Integrative Medicine and Health

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Objective The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic’s acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches. Methods Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests. Results Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant ( P < .05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health ( P = .057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services. Conclusion Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system.

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“…Primary care services may be provided by HIV primary care providers, by generalist primary care providers, or through shared care wherein a HIV subspecialist and a primary care provider collaboratively manage Veterans' primary care needs (Fix et al, 2014). Studies examining differences in cardiovascular disease preventative care in the VHA have not identified a superior care model (Bokhour et al, 2021). Yet, there is a demonstrated need for enhanced cardiovascular disease prevention efforts in people with HIV, particularly for Veterans from underrepresented racial and ethnic groups (Richardson et al, 2016).…”

Section: Enhancing Cardiovascular Disease Prevention In Veterans With...mentioning

confidence: 99%

Team-Based Qualitative Rapid Analysis: Approach and Considerations for Conducting Developmental Formative Evaluation for Intervention Design

et al. 2023

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Qualitative rapid analysis is one of many rapid research approaches that offer a solution to the problem of time constrained health services evaluations and avoids sacrificing the richness of qualitative data that is needed for intervention design. We describe modifications to an established team-based, rapid analysis approach that we used to rapidly collect and analyze semi-structured interview data for a developmental formative evaluation of a cardiovascular disease prevention intervention. Over 18 weeks, we conducted and analyzed 35 semi-structured interviews that were conducted with patients and health care providers in the Veterans Health Administration to identify targets for adapting the intervention in preparation for a clinical trial. We identified 12 key themes describing actionable targets for intervention modification. We highlight important methodological decisions that allowed us to maintain rigor when using qualitative rapid analysis for intervention adaptation and we provide practical guidance on the resources needed to execute similar qualitative studies. We additionally reflect on the benefits and challenges of the described approach when working within a remote research team environment. ClinicalTrials.gov: NCT04545489.

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How Should We Organize Care for Patients With Human Immunodeficiency Virus and Comorbidities? A Multisite Qualitative Study of Human Immunodeficiency Virus Care in the United States Department of Veterans Affairs

Abstract: Supplemental Digital Content is available in the text.

Cited by 6 publications

References 20 publications

Patient and clinician preferences for diabetes management among older adults with co-morbid HIV: A qualitative exploration

Patient and clinician preferences for diabetes management among older adults with co-morbid HIV: A qualitative exploration

Evaluation of a New Integrative Health and Wellness Clinic for Veterans at the San Francisco VA Health Care System: A Mixed-Methods Pilot Study

Team-Based Qualitative Rapid Analysis: Approach and Considerations for Conducting Developmental Formative Evaluation for Intervention Design

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