Patient Preference and Adherence (May 2019)
Older patients’ preferences and views related to non-face-to-face diabetes chronic care management: a qualitative study from southeast Louisiana
Abstract
AN Bazzano,1 AM Monnette,2 MK Wharton,2 EG Price-Haywood,3 E Nauman,4 P Dominick,5 C Glover,5 G Hu,6 L Shi21Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; 2Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; 3Ochsner Health System Center for Applied Health Services Research, New Orleans, LA, USA; 4Louisiana Public Health Institute, New Orleans, LA, USA; 5LEAD Study Steering Committee, New Orleans, LA, USA; 6Pennington Biomedical Research Center, Baton Rouge, LA, USABackground: Management of diabetes may be uniquely challenging for older individuals with multiple chronic conditions. Health systems and policymakers have attempted to reduce barriers to chronic care management (CCM) through incentives to provide non-face-to-face care. This qualitative study aimed to investigate and present views on non-face-to-face care management held by elderly patients with diabetes and other chronic conditions in order to contribute to improved programming for this population.Materials and methods: Semi-structured interviews were conducted with patients over the age of 64 who have been diagnosed with diabetes and at least one other chronic health condition. Interview recordings were transcribed and analyzed by experienced researchers using a thematic analytic approach, and an illustrative case study was developed.Results: Thirty individuals participated in this study. Participants were drawn from three health systems in south Louisiana, an area with high rates of morbidity and mortality related to chronic diseases. We identified themes related to lived experiences with diabetes and other medical conditions, perception of personal health status, perceived value of non-face-to-face programs, and support needs for future programming. Additionally, we present one case study describing in detail an individual patient’s experience with non-face-to-face CCM.Conclusion: Health systems should consider intentionally recruiting participants who would benefit most from non-face-to-face care, including higher-need, less self-sufficient patients with resource constraints, while continuing to offer in-person services. Future research should examine whether tailoring non-face-to-face programming and support to address unique barriers can further enhance diabetes care at the population level.Keywords: diabetes complications, patient care management, aging, patient-centered care
