RESUMEN
OBJECTIVES: Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS: We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged ≥18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis. RESULTS: Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged ≥50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD. CONCLUSIONS: Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.
Asunto(s)
/estadística & datos numéricos , Hepatitis C/epidemiología , Indígenas Norteamericanos/estadística & datos numéricos , Trastornos Relacionados con Opioides/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , United States Indian Health Service/estadística & datos numéricos , United States Indian Health Service/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: The objectives of this study were to use Indian Health Service (IHS) data from electronic health records to analyze human immunodeficiency virus (HIV) diagnoses among American Indian/Alaska Natives (AI/ANs) and to identify current rates and trends that can support data-driven policy implementation and resource allocation for this population. METHODS: We analyzed provider visit data from IHS to capture all AI/AN patients who met a definition of a new HIV diagnosis from 2005 through 2014 by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We calculated rates and trends of new HIV diagnoses by age, sex, region, and year per 100 000 AI/ANs in the IHS user population. RESULTS: A total of 2273 AI/ANs met the definition of newly diagnosed with HIV from 2005 through 2014, an average annual rate of 15.1 per 100 000 AI/ANs. Most (356/391) IHS health facilities recorded at least 1 new HIV diagnosis. The rate of new HIV diagnoses among males (21.3 per 100 000 AI/ANs) was twice as high as that among females (9.5 per 100 000 AI/ANs; rate ratio = 2.2; 95% confidence interval, 2.1-2.4); by age, rates were highest among those aged 20-54 for males and females. By region, the Southwest region had the highest number (n = 1016) and rate (19.9 per 100 000 AI/ANs) of new HIV diagnoses. Overall annual rates of new HIV diagnoses were stable from 2010 through 2014, although diagnosis rates increased among males ( P < .001) and those aged 15-19 ( P < .001), 45-59 ( P < .001), and 50-54 ( P = .01). CONCLUSIONS: New HIV diagnoses, derived from provider visit data, among AI/ANs were stable from 2010 through 2014. AI/ANs aged 20-54, particularly men, may benefit from increased HIV prevention and screening efforts. Additional services may benefit patients in regions with higher rates of new diagnoses and in remote settings in which reported HIV numbers are low.
Asunto(s)
/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Indígenas Norteamericanos/estadística & datos numéricos , Salud Pública/tendencias , United States Indian Health Service/estadística & datos numéricos , United States Indian Health Service/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Predicción , Infecciones por VIH/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Población Rural/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto JovenAsunto(s)
Investigación Biomédica/tendencias , Enfermedades Cardiovasculares/etnología , Necesidades y Demandas de Servicios de Salud/tendencias , Indígenas Norteamericanos , Evaluación de Necesidades/tendencias , United States Indian Health Service/tendencias , Adolescente , Adulto , Anciano , Alaska/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Comorbilidad , Asistencia Sanitaria Culturalmente Competente/etnología , Asistencia Sanitaria Culturalmente Competente/tendencias , Ambiente , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/tendencias , Humanos , Estilo de Vida/etnología , Masculino , Persona de Mediana Edad , Pronóstico , Medición de Riesgo , Factores de Riesgo , Estados Unidos , Adulto JovenRESUMEN
STUDY OBJECTIVE: The Indian Health Service provides health care to eligible American Indians and Alaskan Natives. No published data exist on emergency services offered by this unique health care system. We seek to determine the characteristics and capabilities of Indian Health Service emergency departments (EDs). METHODS: All Indian Health Service EDs were surveyed about demographics and operational characteristics for 2014 with the National Emergency Department Inventory survey (available at http://www.emnet-nedi.org/). RESULTS: Of the forty eligible sites, there were 34 respondents (85% response rate). Respondents reported a total of 637,523 ED encounters, ranging from 521 to 63,200 visits per site. Overall, 85% (95% confidence interval 70% to 94%) had continuous physician coverage. Of all physicians staffing the ED, a median of 13% (interquartile range 0% to 50%) were board certified or board prepared in emergency medicine. Overall, 50% (95% confidence interval 34% to 66%) of respondents reported that their ED was operating over capacity. CONCLUSION: Indian Health Service EDs varied widely in visit volume, with many operating over capacity. Most were not staffed by board-certified or -prepared emergency physicians. Most lacked access to specialty consultation and telemedicine capabilities.
Asunto(s)
Atención a la Salud/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Indígenas Norteamericanos , Calidad de la Atención de Salud/organización & administración , United States Indian Health Service/normas , Estudios Transversales , Atención a la Salud/normas , Servicio de Urgencia en Hospital/normas , Encuestas de Atención de la Salud , Investigación sobre Servicios de Salud , Disparidades en Atención de Salud , Humanos , Calidad de la Atención de Salud/normas , Estados Unidos , United States Indian Health Service/organización & administración , United States Indian Health Service/tendenciasRESUMEN
The passage of the Affordable Care Act in the United States has opened a policy window for the establishment of an independent Medicaid agency for the Navajo Nation. This article explores several policy options to improve health care services for Native Americans. Although there is a lack of scholarly research on the impact of healthcare reform and the effectiveness of current health care programs for American Indians, policymakers should utilize evidence-based research to inform policy decisions.
Asunto(s)
Política de Salud , United States Indian Health Service/tendencias , Accesibilidad a los Servicios de Salud , Humanos , Indígenas Norteamericanos , Patient Protection and Affordable Care Act , Estados UnidosRESUMEN
CONTEXT: Oklahoma has a history of strong partnerships with their tribal health leaders and tribal communities. In 2012, the Oklahoma State Department of Health (OSDH) established the Office of the Tribal Liaison, as Oklahoma has 39 tribal nations in the state, of which 38 are federally recognized. The Office of the Tribal Liaison is responsible for promoting relationships with Oklahoma Tribal Nations and implementing the OSDH Tribal Consultation policy. SETTING: The strength of the partnership between the OSDH and the Tribal Nations enabled a new collaboration during an event hosted by a tribal casino event center that brought tattoo artists to provide tattoos to patrons over 3 days. Licensure issues that crossed the jurisdiction boundaries of the OSDH emerged before the event, which required the OSDH, Indian Health Service, and the Tribal Nation to work together to protect the public's health. The 3 jurisdictions drew upon their previously established partnership, OSDH's tribal consultation policy, and their open and trusting relationship to come together quickly to protect the public's health. CONCLUSIONS: This event and interjurisdictional partnership highlighted the importance of adopting the "Spectrum of Processes for Collaboration and Consensus-Building" model as outlined by Orenstein et al to help guide and support state, tribal, and federal collaborations. This case example highlights the opportunities for collaboration between different regulatory public health and tribal bodies to improve the communities' health.
Asunto(s)
Conducta Cooperativa , Administración en Salud Pública/métodos , United States Indian Health Service/organización & administración , Humanos , Oklahoma , Administración en Salud Pública/tendencias , Estados Unidos , United States Indian Health Service/normas , United States Indian Health Service/tendenciasRESUMEN
AIMS: Patient-centered medical home (PCMH) principles including provider continuity, coordination of care, and advanced access align with healthcare needs of patients with Type II diabetes mellitus (DM-II). We investigate changes in trend for DM-II quality indicators after PCMH implementation at Southcentral Foundation, a tribal health organization in Alaska. METHODS: Monthly rates of DM-II incidence, hemoglobin A1c (HbA1c) measurements, and service utilization were calculated from electronic health records from 1996 to 2009. We performed interrupted time series analysis to estimate changes in trend. RESULTS: Rates of new DM-II diagnoses were stable prior to (p=0.349) and increased after implementation (p<0.001). DM-II rates of HbA1c screening increased, though not significantly, before (p=0.058) and remained stable after implementation (p=0.969). There was non-significant increasing trend in both periods for percent with average HbA1c less than 7% (53 mmol/mol; p=0.154 and p=0.687, respectively). Number of emergency visits increased before (p<0.001) and decreased after implementation (p<0.001). Number of inpatient days decreased in both periods, but not significantly (p=0.058 and p=0.101, respectively). CONCLUSIONS: We found positive changes in DM-II quality trends following PCMH implementation of varying strength and onset of change, as well as duration of sustained trend.
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Diabetes Mellitus Tipo 2/terapia , Recursos en Salud/tendencias , Atención Dirigida al Paciente/tendencias , Atención Primaria de Salud/tendencias , Mejoramiento de la Calidad/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , United States Indian Health Service/tendencias , Alaska/epidemiología , Biomarcadores/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnología , Servicio de Urgencia en Hospital/tendencias , Hemoglobina Glucada/metabolismo , Recursos en Salud/normas , Humanos , Incidencia , Indígenas Norteamericanos , Tiempo de Internación/tendencias , Admisión del Paciente/tendencias , Atención Dirigida al Paciente/normas , Valor Predictivo de las Pruebas , Atención Primaria de Salud/normas , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Factores de Tiempo , Estados Unidos , United States Indian Health Service/normasRESUMEN
BACKGROUND: Asthma, a common chronic disease among adults and children in the United States, results in nearly one-half million hospitalizations annually. There has been no evaluation of asthma hospitalizations for American Indian and Alaska Native (AI/AN) people since a previous study using data for 1988-2002. In this study, we describe the epidemiology and trends for asthma hospitalizations among AI/AN people and the general US population for 2003-2011. METHODS: Hospital discharge records with a first-listed diagnosis of asthma for 2003-2011 were examined for AI/AN people, using Indian Health Service (IHS) data, and for the general US population, using the Nationwide Inpatient Sample. Average annual crude and age-adjusted hospitalization rates were calculated. RESULTS: The average annual asthma hospitalization rates for AI/AN people and the general US population decreased from 2003-2005 to 2009-2011 (32% and 11% [SE, 3%], respectively). The average annual age-adjusted rate for 2009-2011 was lower for AI/AN people (7.6 per 10,000 population) compared with the general US population (13.2 per 10,000; 95% CI, 12.8-13.6). Age-specific AI/AN rates were highest among infants and children 1 to 4 years of age. IHS regional rates declined in all regions except Alaska. CONCLUSIONS: Asthma hospitalization rates are decreasing for AI/AN people and the general US population despite increasing prevalence rates. AI/AN people experienced a substantially lower age-adjusted asthma hospitalization rate compared with the general US population. Although the rates for AI/AN infants and children 1 to 4 years of age have declined substantially, they remain higher compared with other age groups. Improved disease management and awareness should help to further decrease asthma hospitalizations, particularly among young children.
Asunto(s)
Asma/etnología , Asma/epidemiología , Hospitalización/tendencias , Indígenas Norteamericanos , Inuk , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Alaska , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores Sexuales , Estados Unidos/epidemiología , United States Indian Health Service/estadística & datos numéricos , United States Indian Health Service/tendencias , Adulto JovenRESUMEN
The United States has a trust responsibility to provide services to American Indians and Alaska Native (AI/AN) persons. However, a long-standing history of underfunding of the Indian Health Service (IHS) has led to significant challenges in providing services. Twentieth century laws, including the Snyder Act, Transfer Act, Indian Self-Determination and Education Assistance Act, and Indian Health Care Improvement Act (IHCIA) have had an effect on the way health services are provided. IHCIA was reauthorized as part of the Patient Protection and Affordable Care Act (ACA). Several provisions in ACA allow for potential improvements in access to services for AI/AN populations and are described herein. Although policy developments have been promising, IHS underfunding must be resolved to ensure improved AI/AN health.
Asunto(s)
Política de Salud/historia , Indígenas Norteamericanos , United States Indian Health Service/historia , Política de Salud/legislación & jurisprudencia , Política de Salud/tendencias , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Estados Unidos , United States Indian Health Service/legislación & jurisprudencia , United States Indian Health Service/tendenciasRESUMEN
American Indians are at greater risk for Rocky Mountain spotted fever (RMSF) than the general U.S. population. The epidemiology of RMSF among American Indians was examined by using Indian Health Service inpatient and outpatient records with an RMSF International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis. For 2001-2008, 958 American Indian patients with clinical diagnoses of RMSF were reported. The average annual RMSF incidence was 94.6 per 1,000,000 persons, with a significant increasing incidence trend from 24.2 in 2001 to 139.4 in 2008 (P = 0.006). Most (89%) RMSF hospital visits occurred in the Southern Plains and Southwest regions, where the average annual incidence rates were 277.2 and 49.4, respectively. Only the Southwest region had a significant increasing incidence trend (P = 0.005), likely linked to the emergence of brown dog ticks as an RMSF vector in eastern Arizona. It is important to continue monitoring RMSF infection to inform public health interventions that target RMSF reduction in high-risk populations.
Asunto(s)
Indígenas Norteamericanos , Fiebre Maculosa de las Montañas Rocosas/diagnóstico , Fiebre Maculosa de las Montañas Rocosas/epidemiología , United States Indian Health Service/tendencias , Adolescente , Adulto , Anciano , Animales , Arizona/epidemiología , Niño , Preescolar , Perros , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Clasificación Internacional de Enfermedades , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Rhipicephalus sanguineus , Fiebre Maculosa de las Montañas Rocosas/transmisión , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: We described the changing epidemiology of viral hepatitis among the American Indian/Alaska Native (AI/AN) population that uses Indian Health Service (IHS) health care. METHODS: We used hospital discharge data from the IHS National Patient Information Reporting System to determine rates of hepatitis A-, B-, and C-associated hospitalization among AI/ANs using IHS health care from 1995-2007 and summary periods 1995-1997 and 2005-2007. RESULTS: Hepatitis A-associated hospitalization rates among AI/AN people decreased from 4.9 per 100,000 population during 1995-1997 to 0.8 per 100,000 population during 2005-2007 (risk ratio [RR] = 0.2, 95% confidence interval [CI] 0.1, 0.2). While there was no significant change in the overall hepatitis B-associated hospitalization rate between time periods, the average annual rate in people aged 45-64 years increased by 109% (RR=2.1, 95% CI 1.4, 3.2). Between the two time periods, the hepatitis C-associated hospitalization rate rose from 13.0 to 55.0 per 100,000 population (RR=4.2, 95% CI 3.8, 4.7), an increase of 323%. The hepatitis C-associated hospitalization rate was highest among people aged 45-64 years, males, and those in the Alaska region. CONCLUSIONS: Hepatitis A has decreased to near-eradication levels among the AI/AN population using IHS health care. Hepatitis C-associated hospitalizations increased significantly; however, there was no significant change in hepatitis B-associated hospitalizations. Emphasis should be placed on continued universal childhood and adolescent hepatitis B vaccination and improved vaccination of high-risk adults. Prevention and education efforts should focus on decreasing hepatitis C risk behaviors and identifying people with hepatitis C infection so they may be referred for treatment.
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Hepatitis Viral Humana/epidemiología , Hospitalización/tendencias , Indígenas Norteamericanos/estadística & datos numéricos , Inuk/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Alaska/epidemiología , Niño , Preescolar , Femenino , Hepatitis Viral Humana/clasificación , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología , United States Indian Health Service/estadística & datos numéricos , United States Indian Health Service/tendencias , Adulto JovenRESUMEN
BACKGROUND: Although Native Americans experience substantial disparities in health outcomes, little information is available regarding healthcare delivery for this population. OBJECTIVE: To analyze trends in ambulatory quality of care and physician reports of barriers to quality improvement within the Indian Health Service (IHS). DESIGN: Longitudinal analysis of clinical performance from 2002 to 2006 within the IHS, and a physician survey in 2007. PARTICIPANTS: Adult patients cared for within the IHS and 740 federally employed physicians within the IHS. MAIN MEASURES: Clinical performance for 12 measures of ambulatory care within the IHS; as well as physician reports of ability to access needed health services and use of quality improvement strategies. We examined the correlation between physician reports of access to mammography and clinical performance of breast cancer screening. A similar correlation was analyzed for diabetic retinopathy screening. KEY RESULTS: Clinical performance significantly improved for 10 of the 12 measures from 2002 to 2006, including adult immunizations, cholesterol testing, and measures of blood pressure and cholesterol control for diabetes and cardiovascular disease. Breast cancer screening rates decreased (44% to 40%, p = 0.002), while screening rates for diabetic retinopathy remained constant (51%). Fewer than half of responding primary care physicians reported adequate access to high-quality specialists (29%), non-emergency hospital admission (37%), high-quality imaging services (32%), and high-quality outpatient mental health services (16%). Breast cancer screening rates were higher at sites with higher rates of physicians reporting routine access to mammography compared to sites with lower rates of physicians reporting such access (46% vs. 35%, ρ = 0.27, p = 0.04). Most physicians reported using patient registries and decision support tools to improve patient care. CONCLUSIONS: Quality of care has improved within the IHS for many services, however performance in specific areas may be limited by access to essential resources.
Asunto(s)
Atención Ambulatoria/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Indígenas Norteamericanos , Mejoramiento de la Calidad/tendencias , Calidad de la Atención de Salud/tendencias , United States Indian Health Service/tendencias , Adolescente , Adulto , Anciano , Atención Ambulatoria/normas , Competencia Clínica/normas , Recolección de Datos/métodos , Femenino , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud/normas , Disparidades en Atención de Salud/tendencias , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad/normas , Calidad de la Atención de Salud/normas , Estados Unidos , United States Indian Health Service/normas , Adulto JovenAsunto(s)
Atención a la Salud/organización & administración , Sistemas de Información/organización & administración , Garantía de la Calidad de Atención de Salud/métodos , Administración de la Seguridad/métodos , United States Indian Health Service/tendencias , Prescripciones de Medicamentos , Humanos , Indígenas Norteamericanos , Sistemas de Información/tendencias , Sistemas de Registros Médicos Computarizados , Garantía de la Calidad de Atención de Salud/organización & administración , Estados UnidosAsunto(s)
Administración de los Servicios de Salud , Indígenas Norteamericanos , United States Indian Health Service , Gobierno Federal/historia , Administración de los Servicios de Salud/historia , Administración de los Servicios de Salud/tendencias , Historia del Siglo XX , Humanos , Indígenas Norteamericanos/historia , Indígenas Norteamericanos/legislación & jurisprudencia , Relaciones Raciales/historia , Relaciones Raciales/legislación & jurisprudencia , Estados Unidos/etnología , United States Indian Health Service/historia , United States Indian Health Service/tendenciasRESUMEN
The many unique aspects of Indian life extend into the health care arena, of special interest in Oklahoma, the "home of the red man." The long historical relationship of certain Indian tribes with the federal government has resulted in one of the most complicated social, administrative, and governmental arrangements anywhere. A consequence of this relationship was, in effect, a business transaction resulting in the ceding of virtually all Indian lands of the U.S. and an assumption by the latter to provide certain services, including health care, to affected tribes. With the 33 different tribes in Oklahoma; the dual entitlement possessed by Indian people; the contributions of the Indian Health Service to the economy of Oklahoma; and the growing revolution in health care, knowledge of the special circumstances of Indian life and health care is important even for practitioners who do not regularly encounter Indian people in their own practices.
Asunto(s)
Accesibilidad a los Servicios de Salud , Accesibilidad a los Servicios de Salud/normas , Indígenas Norteamericanos , United States Indian Health Service , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Oklahoma , Estados Unidos , United States Indian Health Service/normas , United States Indian Health Service/tendenciasRESUMEN
PURPOSE: To identify key systems issues from the Indian Health Service (IHS) experience that must be addressed to improve metabolic control among patients with non-insulin-dependent diabetes mellitus (NIDDM) who were followed in primary care settings. DATA SOURCES: Records of diabetic patients seen in IHS facilities in specific geographic regions from 1987 to 1994. STUDY SELECTION: A representative sample of charts from each facility was reviewed yearly to measure key variables. The sampling frame was the number of diabetic patients currently active on the registry and the sample size calculated to measure a 10% change in selected practices at each facility. EXTRACTION: Regional diabetes coordinators reviewed charts or trained local providers to sample and extract data in a standard format. RESULTS: Regional data were examined to show trends in the performance of immunizations and foot examinations and in other variables such as hypertension and metabolic control. The percentage of diabetic patients who received a single dose of pneumococcal vaccine improved from 24% in 1987 to 1988 to 57% in 1994 (P < 0.01 for trend) among diabetic patients in Minnesota, Wisconsin, and Michigan. Rates of yearly comprehensive foot examination increased from 36% to 58% (P < 0.01 for trend) over the same period. In Montana and Wyoming, the percentage of diabetic patients with uncontrolled hypertension (defined as the mean of three systolic blood pressure measurements of > or = 140 mm Hg or diastolic pressure measurements > or = 90 mm Hg, or both, during the previous year) decreased from 36% in 1992 to 25% in 1993 after the regional diabetes coordinator emphasized hypertension control. In 1994, when less emphasis was placed on hypertension, 33% of the diabetic patients had uncontrolled hypertension. Estimates of metabolic control from records of diabetic patients in Washington, Oregon, and Idaho in 1994 showed that 29% of patients had excellent metabolic control (a hemoglobin A1c [HbA1c] level < or = 7.5% or mean blood glucose level < or = 9.2 mmol/L) within the past year; only 9% experienced poor control (a HbA1c level > 12% or mean blood glucose level > 18.9 mmol/L). CONCLUSIONS: The IHS experience shows that standard, ongoing monitoring of key variables allows facilities to improve diabetes care. Simple, reliable methods of defining metabolic control combined with a feedback system in the primary care setting are needed to improve metabolic control in patients with NIDDM.
Asunto(s)
Diabetes Mellitus Tipo 2 , Atención Primaria de Salud/normas , United States Indian Health Service/organización & administración , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Humanos , Registros Médicos , Vigilancia de la Población , Atención Primaria de Salud/tendencias , Estados Unidos/epidemiología , United States Indian Health Service/normas , United States Indian Health Service/tendenciasRESUMEN
Minnesota's urban and rural Indian communities today face a similar set of complex and daunting health problems. No one overriding issue exists, nor does an overall solution. While staff shortages, a dire lack of Indian health professionals, and inadequate financial resources play a role, poverty, racism, lifestyle, alcoholism, and cultural change and conflict all further complicate health problems for Indian people.