Clinical Pharmacy Services among Veterans with Chronic Kidney Disease: Associations with Rural Residence and Primary...

To compare clinical pharmacist practitioner (CPP) service receipt among Veterans with chronic kidney disease (CKD) by rural/urban residence and by primary care site, and to describe CPP telehealth use.

Using Veterans Health Administration data, we identified Veterans with CKD (N=699,273), defined by two eGFR values <60 mL/min/1.73 m2 (≥90 days apart) and ≥1 primary care visit in 2019. Rurality was based on Rural-Urban Commuting Area codes. The primary outcome was ≥1 outpatient CPP encounter; secondary outcomes were CPP encounter frequency and telehealth use. We used multivariable logistic regression with a random intercept for health system.

Overall, 18% of urban and 17% of rural Veterans had ≥1 CPP encounter. After adjustment, rural Veterans were slightly more likely to have a CPP encounter (adjusted odds ratio [aOR] 1.05; 95% confidence interval [CI] 1.03-1.07). Differences were larger by primary care site: 21% at medical centers, 16% at urban clinics (aOR 0.69; 95% CI 0.68-0.70) and 14% at rural clinics (aOR 0.61; 95% CI 0.59-0.62). Among Veterans with ≥1 CPP encounter (n=124,490, 17.8%), rural Veterans had slightly more CPP encounters than urban Veterans (4.6 vs 4.3). CPP telehealth comprised 53.7% of encounters and varied by primary care site (56.5% medical centers, 48.8% urban clinics, 62.8% rural clinics).

Rural-urban differences in CPP receipt were small after adjustment, but Veterans receiving primary care in community clinics had lower CPP receipt than those at medical centers. Telehealth may support expanded CPP access for Veterans with CKD.