228649 No stone unturned: American Indians Accessing Health Care

Monday, November 8, 2010 : 9:10 AM - 9:30 AM

Brenda Seals, PhD, MPH , Rides Over Mountains Consulting, Bailey, CO
Denise Lindstrom , Native American Cancer Research, Lakewood, CO
Delight Satter, MPH , Community Health Sciences, UCLA, School of Public Health, Los Angeles, CA
Tinka Duran , Northern Plains Comprehensive Cancer Control Program, Aberdeen Area Tribal Chairman's Health Board, Rapid City, SD
Noel L. Pingatore, BS CPH , Health Services Division, Inter-Tribal Council of Michigan, Sault Ste. Marie, MI
Lance Allrunner , Native American Cancer Research, Lakewood, CO
Linda Burhansstipanov, DrPH , Native American Cancer Research Corporation, Pine, CO
Background: One of the biggest health disparities for American Indians (AI) is the delay of accessing care. In cancer, many who are diagnosed early (Stage 1), may progress to Stage 2 or beyond before they access care. Much delay is due to health care organizational factors determining services available and not available on reservations and urban areas. AIs may not be aware of how to access care and assume care is readily available. Unfortunately, new health problem leave many AIs struggling to access timely care.

Method: Focus groups were held in four regions including two urban (Los Angeles, Denver) and rural areas (Michigan and North Dakota). Focus groups were analyzed by two independent coders and reviewed by the research team.

Results: AIs traveled great distances for services, many going between cities and reservations, hundreds of miles apart. Many state employees did not have accurate information about Indian Health Service (IHS) limits and participants found explaining this difficult. Such poor communication led to delayed services for those ultimately found eligible. Gaps exist in available health services and resources for medications and therapy. Many went without care. Some facilities helped AIs access care by going around the rules.

Conclusions: Significant health disparities will continue for AIs until a seamless health care system can provide comprehensive care and bridge gaps between urban and rural (reservation) areas. State programs could benefit from training front line, eligibility case managers on IHS limits. Breast and Cervical Early Detection programs could be models for health screening and care.

Learning Areas:
Communication and informatics
Diversity and culture
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
List at least three gaps in health services for American Indians. Describe at least three ways that delays in accessing care can be shortened for Americans Indians. Articulate the training needs of those who screen American Indians for eligibility for state, local and American Indian specific health systems. Discuss program models for bridging American Indian specific and state health care systems.

Keywords: Access to Care, American Indians

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked with American Indians on improving access to health care for over 12 years, first with HIV/AIDS, now in cancer. As a former CDC, faculty and health consultant, I have a wide range of experience in policy and practice that impacts health disparities. I widely publish administrative and policy results and dissemination American Indian specific information.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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