A qualitative assessment of pelvic floor physical therapy experiences for women Veterans in VHA care

Abstract: Background: Nearly 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. Objective: To characterize women Veterans’ experiences with PFPT, including factors affecting access to and receipt of care. Design: Using VHA data, we recruited and conducted semi-structured qualitative interviews with women Veterans who had received PFPT services within the last 6 months. Participants: We 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). Approach: We 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 Results: We 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. Conclusions: Findings 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.