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

TL;DR

This study explores how older adults with HIV and diabetes prefer managing their care, and what clinicians think about treating both conditions together.

Contribution

The study identifies patient and clinician preferences for integrated HIV and diabetes care in older adults.

Findings

Patients prefer either a single clinician for both HIV and diabetes or separate specialists for each condition.

Clinicians are comfortable screening for diabetes but often refer complex cases to specialists.

Both patients and clinicians expressed a need for better education and streamlined referral systems.

Abstract

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.

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.

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.

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.

Figures