Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People
ABSTRACT The Indian Health Service (IHS), a federal health system, cares for 2 million of the country's 5.2 million American Indian and Alaska Native people. This system has increasingly focused on innovative uses of health information technology and telemedicine, as well as comprehensive, locally tailored prevention and disease management programs, to promote health equity in a population facing multiple health disparities. Important recent achievements include a reduction in the life-expectancy gap between American Indian and Alaska Native people and whites (from eight years to five years) and improved measures of diabetes control (including 20 percent and 10 percent reductions in the levels of low-density lipoprotein cholesterol and hemoglobin A1c, respectively). However, disparities persist between American Indian and Alaska Native people and the overall US population. Continued innovation and increased funding are required to further improve health and achieve equity.
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- "These findings accord with Canadian data revealing higher prevalences of cardiovascular disease , heart failure , and diabetes . While some progress has been made towards addressing these disparities , , , profound differences remain between the health status of Aboriginal and non-Aboriginal people. "
ABSTRACT: Background It is widely recognised that significant discrepancies exist between the health of indigenous and non-indigenous populations. Whilst the reasons are incompletely defined, one potential cause is that indigenous communities do not access healthcare to the same extent. We investigated healthcare utilisation rates in the Canadian Aboriginal population to elucidate the contribution of this fundamental social determinant for health to such disparities. Methods Healthcare utilisation data over a nine-year period were analysed for a cohort of nearly two million individuals to determine the rates at which Aboriginal and non-Aboriginal populations utilised two specialties (Cardiology and Ophthalmology) in Alberta, Canada. Unadjusted and adjusted healthcare utilisation rates obtained by mixed linear and Poisson regressions, respectively, were compared amongst three population groups - federally registered Aboriginals, individuals receiving welfare, and other Albertans. Results Healthcare utilisation rates for Aboriginals were substantially lower than those of non-Aboriginals and welfare recipients at each time point and subspecialty studied [e.g. During 2005/06, unadjusted Cardiology utilisation rates were 0.28% (Aboriginal, n = 97,080), 0.93% (non-Aboriginal, n = 1,720,041) and 1.37% (Welfare, n = 52,514), p = <0.001]. The age distribution of the Aboriginal population was markedly different [2.7%≥65 years of age, non-Aboriginal 10.7%], and comparable utilisation rates were obtained after adjustment for fiscal year and estimated life expectancy [Cardiology: Incidence Rate Ratio 0.66, Ophthalmology: IRR 0.85]. Discussion The analysis revealed that Aboriginal people utilised subspecialty healthcare at a consistently lower rate than either comparatively economically disadvantaged groups or the general population. Notably, the differences were relatively invariant between the major provincial centres and over a nine year period. Addressing the causes of these discrepancies is essential for reducing marked health disparities, and so improving the health of Aboriginal people.PLoS ONE 11/2012; 7(11):e48355. DOI:10.1371/journal.pone.0048355 · 3.23 Impact Factor
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ABSTRACT: In the past decade and a half, the United States has witnessed major advances in the recognition and reporting of health and health care disparities. Now is the time to move beyond describing these disparities to actually eliminating them. Because of the interlocking nature of disparities in health, disparities in health care, and the role of social determinants, there is a need to focus our efforts on one primary goal: achieving health equity by securing access for the entire population to the highest possible quality of health care. Access to high-quality care for populations of color can have the same impact as it has for majority populations: improving population health, improving patients' experiences of care, and reducing health care costs.Health Affairs 10/2011; 30(10):1868-71. DOI:10.1377/hlthaff.2011.0976 · 4.64 Impact Factor
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ABSTRACT: In this special feature article, we discuss the development of collaborative care models in chronic disease management and the need for such initiatives in chronic kidney disease (CKD). We identify telemedicine as a potential key element to collaborative care in CKD. Telenephrology-as telemedicine would be referred to as it is applied in CKD-would be comprised of various technology platforms and applications, which are described here. We describe a range of scenarios in which telenephrology would facilitate collaborative care in CKD and how it would be the basis for patient-oriented research to assess improvements in outcomes in the future.Nephrology Dialysis Transplantation 12/2012; 28(4). DOI:10.1093/ndt/gfs552 · 3.49 Impact Factor