Expansion of Access to Rheumatology Care for Rural Veterans: Program Development and Initial Feasibility of the...

Area of Science:

• Health Services Research
• Telemedicine
• Rheumatology

Background:

• Access to specialized care, such as rheumatology, remains a challenge for Veterans, particularly those in rural areas.
• The Veterans Affairs (VA) system faces unique hurdles in delivering consistent care to geographically dispersed populations.

Purpose of the Study:

• To assess the initial feasibility of the National Tele-Rheumatology Program (NTRP), a hub-and-spoke telehealth model.
• To evaluate the program's effectiveness in expanding rheumatology care access for rural Veterans.

Main Methods:

• The RE-AIM framework guided the analysis of VA program records, EHR data, and participant feedback from July 2024 to June 2025.
• Feasibility was measured by spoke site enrollment, rural reach, encounter volume, non-VA care changes, Veteran satisfaction, and implementation barriers.

Main Results:

• Eleven spoke sites enrolled, reaching 1227 Veterans (47% rural/highly rural) with 2577 encounters.
• 89.3% of Veterans with prior non-VA claims had none after their first NTRP visit; satisfaction was moderate to high.
• Challenges included technology access and virtual care reluctance, addressed by adaptations like tech support.

Conclusions:

• The NTRP demonstrates promising early feasibility, successfully reaching its target rural Veteran population.
• The program is acceptable to Veterans and shows potential for reducing non-VA care use.
• Further evaluation is needed for sustainment, costs, and clinical outcomes, especially rural-specific ones.