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Kidney Week

Abstract: PO2345

Need and Preference Assessments for Renal Care and Comprehensive Pre-ESKD Education Services for Advanced CKD Veterans

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Chamarthi, Gajapathiraju, University of Florida, Gainesville, Florida, United States
  • Purvis, Zachary Pitt, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Ly, Lina, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Hale-Gallardo, Jennifer, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Jia, Huanguang, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
Background

Current guidelines suggest Specialty Renal Care (SRC) and comprehensive pre-end-stage kidney disease (ESKD) education (CPE) Services for all patients with advanced, stage 4/5 chronic kidney disease (CKD). Despite this, half of incident ESKD patients receive none or <6months pre-ESKD renal care. Estimating outstanding needs and understanding Veterans preferences for receiving such care can improve resource allocations and quality of care for Veterans Health Administration(VHA). We conducted a community-based evaluation of advanced CKD Veterans to assess their current state of and outstanding needs and preferences for SRC and CPE at North Florida/South Georgia(NF/SG) VHA system(VHS).

Methods

Through an iterative approach of electronic health records(EHR) query followed by manual review of randomly selected EHRs, we created a model for isolating advanced CKD cohort at NF/SG VHS. We then sorted the cohort in a random order, and mail-invited Veterans with up to three attempted calls for those who do not call back to actively opt-out of participation. Surveys were conducted for those agreeable for participation.

Results

Of the 148,164 active enrollees, we identified 1329 (0.9%) Veterans with advanced CKD. Of the 226 Veterans randomly selected mail-invites, 166 made final contact; 94 completed, 50 asked for more time, and 22 refused to participate in the surveys. Awareness of CKD (91%) and prevalence of renal care (86%) were high among respondents albeit, 40(50%) received renal care from non-VA providers. Aggregate outstanding need for VA-preferred SRC and CPE were 14(15%) and 69(73%) respectively. Among these, the preferences for receiving SRC were 6(43%) & 8(57%) and receiving CPE were 21(30%) & 34(50%) through in-person and telemedicine-based care respectively. There were significant differences in needs and preferences across the socio-demographics and rural-urban spectrum.

Conclusion

Despite high awareness of CKD diagnosis and prevalence of SRC, there is significant outstanding need for targeted CPE services in advanced CKD Veterans. Further validation of this model at additional VHSs and its application across the system can allow projection of outstanding needs for SRC and CPE across the VHA and guide appropriate allocation of resources to improve Veteran outcomes.

Funding

  • Veterans Affairs Support