Sharpe Jason A, Shapiro Abigail, Goode Adam, Whitfield Chelsea, Gierisch Jennifer, Goldstein Karen, Allen Kelli D
Veterans Affairs Durham, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
Arch Rehabil Res Clin Transl. 2022 Nov 12;5(1):100243. doi: 10.1016/j.arrct.2022.100243. eCollection 2023 Mar.
To assess factors influencing Veterans' decisions to initiate physical therapy (PT) after referral for low back pain (LBP) or knee osteoarthritis (OA).
Qualitative study using individual semistructured telephone interviews.
Durham Veterans Health Administration Health Care System.
A total of 44 Veteran patients (N=44) aged 26-85 were referred for LBP or knee OA between January and August 2021.
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.
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.
评估影响退伍军人在因腰痛（LBP）或膝关节骨关节炎（OA）被转诊后开始接受物理治疗（PT）的因素。
采用个人半结构化电话访谈的定性研究。
达勒姆退伍军人健康管理局医疗保健系统。
2021年1月至8月期间，共有44名年龄在26 - 85岁之间的退伍军人患者因腰痛或膝关节骨关节炎被转诊。
影响开始接受物理治疗的患者层面因素包括对医疗系统导航的困惑、对物理治疗效果的信念以及对物理治疗师诊断其疼痛能力的看法。在医疗服务提供者层面，关于物理治疗护理的讨论似乎会增加开始接受物理治疗的比例。在系统层面，影响因素包括等待时间、非工作时间预约的可获得性以及易于到达的地点。动机主题包括促使受访者开始接受治疗的症状和功能限制。受访者建议，通过当日或快速预约来改变等待时间、提供协助并简化预约流程、提供交通支持、设置便利的护理地点以及提供有关物理治疗的信息（包括其益处），可以改善物理治疗的可及性。
这项关于患者在被转诊后开始接受物理治疗护理的认知研究，确定了腰痛或膝关节骨关节炎受访者在患者、医疗服务提供者和系统层面存在的切实护理障碍。患者知识和系统层面的障碍，包括医疗系统导航的挑战性，是导致患者在被转诊后减少使用物理治疗的主要因素。医疗系统和物理治疗师应通过患者教育、预约协助以及对医疗保健系统的改变（包括当日预约选项）来消除护理障碍。
