As a leader in healthcare, the Department of Veteran Affairs (VA) is transforming to a patient-centered model where care is personalized, proactive and patient-driven; health and wellbeing are situated within patients' life contexts. Complex patients, such as those with HIV, may benefit in particular from this transformation to a patient-centered model of care. HIV is now a chronic condition; Veterans with HIV are living longer. Consequently, comorbidities are often of greater importance to their overall health than HIV status alone and a major concern of providers. Further complicating disease management, patients with HIV have less education, high unemployment, and are more likely to live in poverty or experience homelessness. Yet, HIV providers may not be attuned to patient life contexts and, as specialists, may not be comfortable managing comorbidities. Patient-centered management of HIV necessitates providers ask about patients' life context, learn about their daily activities and priorities, and then tailor care plans accordingly.
1) Understand how Veterans with HIV engage in health behaviors in the context of their daily lives. 2) Explore how HIV providers consider the role of patient context and comorbidities when providing care. 3) Examine communication between HIV providers and their aging patients to understand how they attend to context and comorbidities.
The objectives will be accomplished through three projects. Project 1 will be an ethnographic exploration of patients' illnesses experiences situated in their daily-lives and contexts. Patients with HIV will be interviewed and observed as they go about daily activities. Project 2 will examine how HIV providers attend to and incorporate patient contexts and comorbidities when providing care. General HIV clinic functioning will be observed and providers will be interviewed. Project 3 will examine how providers attend to and incorporate context in clinical interactions with patients with HIV. Patient-provider clinical encounters will be recorded and analyzed, to identify elements of comorbidity management, attention to context and shared-decision making.
Not yet available.
External Links for this Project
Grant Number: IK2HX001783-01A2
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Aging, Older Veterans' Health and Care, Infectious Diseases