A Qualitative Assessment of Pelvic Floor Physical Therapy Experiences for Women Veterans in VHA Care.

BackgroundNearly 25% of women experience pelvic floor disorders, for which pelvic floor physical therapy (PFPT) is a first-line treatment. Within the Veterans Health Administration (VHA), only one-third of health care systems offer PFPT on site. Alternatives include receiving care from providers in the community ("Community Care") or from VHA providers at a distant site via telehealth ("Clinical Resource Hub"). Little is known about Veterans' experiences with these two PFPT care pathways.ObjectiveTo characterize women Veterans' experiences with PFPT, including factors affecting access to and receipt of care.DesignUsing VHA data, we recruited and conducted semi-structured qualitative interviews with women Veterans who had received PFPT services within the last 6 months.ParticipantsWe recruited N = 20 women Veterans from five VHA health care systems. Participants from four health care systems went through the Community Care pathway (N = 12), while participants from the fifth went through the Clinical Resource Hub (N = 8).ApproachWe recorded and auto-transcribed semi-structured interviews. Using structured interview summaries, we completed a two-step analysis process, first using rapid, team-based matrix analysis, followed by thematic analysis. We identified key themes and domains into which we organized those themes.Key resultsWe identified themes in three domains: barriers getting care, experiences of care, and barriers extending care. Veterans described barriers to receiving care initially, including a lack of knowledge, stigma, providers dismissing concerns, and referral challenges. Participants were generally satisfied with their care and experienced quality of life improvements. Most desired some in-person care. Patients wanting more care after completing initially approved visits faced additional administrative barriers, leading to symptom recurrence.ConclusionsFindings about patient access barriers suggest provider training and education (including awareness of PFPT's clinical benefits, referral pathways, and trauma-informed care), patient education, hybrid care modalities, expansion of the PFPT provider workforce, and streamlining referrals may improve access to PFPT among Veterans.