Abstract: TH-PO1050
Multilevel Barriers and Facilitators to CKD Care in Rural Veterans: A CFIR-Guided Qualitative Study
Session Information
- CKD: Epidemiology, Risk Factors, and Other Conditions
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Swee, Melissa L., University of Iowa Health Care, Iowa City, Iowa, United States
- Adeagbo, Morolake J, University of Iowa Health Care, Iowa City, Iowa, United States
- Yamada, Masaaki, University of Iowa Health Care, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Health Care, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Reisinger, Heather, University of Iowa Health Care, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
Living in a rural area is associated with decreased access to nephrology care, and rural patients with chronic kidney disease (CKD) are less likely to receive guideline-concordant CKD care. We explored the experiences of frontline primary care providers (PCPs) in Veterans Health Administration (VHA) to inform responsive care models for rural Veterans with CKD.
Methods
This qualitative study included semi-structured interviews with 12 PCPs from both rural and non-rural clinics affiliated with the Iowa City VA Healthcare System. Interviews were guided by the Consolidated Framework for Implementation Research (CFIR) to capture multilevel factors influencing CKD care delivery. Audio recordings were transcribed, de-identified, and analyzed using a hybrid approach of deductive (CFIR-informed) and inductive thematic coding in MAXQDA.
Results
Three themes emerged from provider narratives. First, PCPs described key differences in CKD care processes for rural Veterans, noting delays in diagnosis, follow-up, and access to nephrology services. Second, participants identified structural barriers, including short appointment times, fragmented care coordination, travel burdens, and digital access gaps, that complicated care delivery. Finally, clinicians reported using adaptive strategies such as close monitoring, patient education, interprofessional collaboration, and the use of telehealth tools to manage CKD locally. Participants also recommended system-level enhancements, including expanded virtual nephrology support and structured CKD education tailored for rural populations.
Conclusion
PCPs describe persistent, multifactorial barriers that complicate the delivery of timely and coordinated CKD care for rural Veterans. Despite these challenges, PCPs reported adapting care to meet the unique needs of rural Veterans and identified several opportunities to enhance CKD management. Scalable interventions including telehealth optimization, interdisciplinary support, and tailored patient education were seen as key strategies to improve care delivery and mitigate geographic barriers within the VHA system.
Funding
- Other NIH Support