Assessing Rural Veterans' Experiences with a Tele-Nephrology Program in the Veterans Health Administration (VHA).

Introduction: Rural living Veterans with chronic kidney disease (CKD) and refractory hypertension (rHTN) have a higher mortality rate and are hospitalized more frequently than Veterans living in urban or suburban areas. They also face particularly unique challenges in accessing nephrology specialty care. Previous studies suggest virtual nephrology care can be used to increase access to care for Veterans. The purpose of this study was to examine Veteran's perceptions and experiences with a VA virtual nephrology program.

Methods: We conducted semi-structured interviews with forty-four Veterans at five rural VA medical centers who were receiving virtual nephrology care ("tele-nephrology").

Results: Four major themes arose that represent the Veterans' perceptions and experiences with VA virtual nephrology care: 1) Tele-nephrology provides timely access to care for Veterans living in rural areas; 2) Clinical partnerships between primary care and tele-nephrology are key to Veterans' health; 3) Veterans' technology fears were assuaged with virtual nephrology care; 4) Improvements to care include more direct access to virtual nephrologists.

Conclusion: This evaluation represents an important step forward in how the VA can enhance virtual nephrology care to better meet the needs of rural Veterans receiving care at facilities without VA specialty providers. Prior to the Choice and MISSION Acts, Veterans were often required to drive long distances to the closest VA specialty provider. However, since the COVID-19 pandemic, the VA has been shifting care from community to VA via virtual care. Further research should examine Veterans' experiences with both different modalities of nephrology care as well as experiences from demographically and geographically diverse Veterans.