Mattocks Kristin M, Kroll-Desrosiers Aimee, Crowley Susan, Tuozzo Katherine, Rifkin Ian, Moore David, Walker Lorrie, Bonegio Ramon
VA Central Western Massachusetts Healthcare System, Leeds, MA, United States.
Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Front Health Serv. 2023 Sep 13;3:1205951. doi: 10.3389/frhs.2023.1205951. eCollection 2023.
Chronic kidney disease (CKD) and refractory hypertension (rHTN) are common, chronic conditions that affect 10%-16% of Veterans. Several small studies have suggested that tele-nephrology can deliver nephrology care effectively to rural Veterans. The purpose of this evaluation was to examine perceptions and experiences with this tele-nephrology program among spoke site staff and clinicians using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to guide our understanding of tele-nephrology implementation.
We conducted semi-structured interviews with fourteen clinicians at five tele-nephrology spoke sites. We used content analysis to analyze the results using our RE-AIM framework.
Five major themes arose: (1) Active engagement of a centralized clinical champion was a key factor in early success of tele-nephrology program; (2) Transition from community-based nephrology to VA tele-nephrology was heralded as the most meaningful indicator of the effectiveness of the intervention; (3) Effective adoption strategies included bi-weekly training with Hub nephrology staff and engagement of a local renal champion; (4) Meeting the needs of Veterans through proper staffing during tele-nephrology examinations was a key priority in facility program implementation; and (5) Growing reliance on Hub nephrologists may give rise to insufficient availability of nephrology appointments in some Spoke sites.
This evaluation represents an important step forward as VA considers how to provide care to Veterans at facilities without VA specialty providers. The COVID-19 pandemic has drastically shifted options for Veterans, and increasingly, the VA is moving to shift care from community to VA via virtual care. Further research should examine how the VA manages potential problems related to access to virtual providers and examine Veteran perspectives on community in-person vs. virtual VA care.
慢性肾脏病（CKD）和难治性高血压（rHTN）是常见的慢性疾病，影响着10%-16%的退伍军人。几项小型研究表明，远程肾脏病学可以有效地为农村退伍军人提供肾脏病护理。本评估的目的是使用“覆盖、效果、采用、实施和维持”（RE-AIM）框架来指导我们对远程肾脏病学实施的理解，考察分支站点工作人员和临床医生对该远程肾脏病学项目的看法和体验。
我们对五个远程肾脏病学分支站点的14名临床医生进行了半结构化访谈。我们使用内容分析法，依据RE-AIM框架分析结果。
出现了五个主要主题：（1）有一位积极参与的中心临床倡导者是远程肾脏病学项目早期成功的关键因素；（2）从社区肾脏病学向退伍军人事务部（VA）远程肾脏病学的转变被视为干预效果最有意义的指标；（3）有效的采用策略包括每两周与中心肾脏病学工作人员进行培训以及让当地肾脏领域倡导者参与；（4）在远程肾脏病学检查期间通过合理配备人员来满足退伍军人的需求是机构项目实施的关键优先事项；（5）对中心肾脏病医生的依赖增加可能导致一些分支站点肾脏病预约的可获得性不足。
随着退伍军人事务部考虑如何在没有退伍军人事务部专科提供者的机构为退伍军人提供护理，本次评估是向前迈出的重要一步。2019冠状病毒病大流行极大地改变了退伍军人的选择，而且退伍军人事务部越来越多地通过虚拟护理将护理从社区转移到退伍军人事务部。进一步的研究应考察退伍军人事务部如何管理与获得虚拟提供者相关的潜在问题，并考察退伍军人对社区面对面护理与退伍军人事务部虚拟护理的看法。
