Rural American Indian and Alaska Native Veterans' Telemental Health: A Model of Culturally Centered Care
Rural American Indian and Alaska Native Veterans' Telemental Health: A Model of Culturally Centered Care
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DOI：
10.1037/ser0000149
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发表时间：
2017-08-01
影响因子：
2.3
通讯作者：
Shore, Jay H.
中科院分区：
文献类型：
--
作者：
Goss, Cynthia W.;Richardson, W. J. Buck;Shore, Jay H.
生活在农村地区的美洲印第安人和阿拉斯加原住民 (AI/AN) 退伍军人具有独特的医疗保健需求，并在获得医疗保健服务方面面临众多障碍。在这些需求中，创伤后应激障碍和其他精神疾病的患病率过高。自 2001 年以来，14 个农村社区与美国退伍军人事务部以及科罗拉多大学安舒茨医学校区的美洲印第安人和阿拉斯加原住民健康中心合作，为美洲印第安退伍军人提供远程心理健康诊所。之前已经对这些诊所的行政和某种程度上的临床考虑进行了审查。本文描述了一种历经 14 年演变而来的护理模式，该模式将循证西方治疗、传统原住民治疗和农村原住民社区编织成 4 个主要组成部分：心理健康护理、技术、护理协调和文化促进。我们描述了通过解决系统转移、提供者与患者之间的信任和视频会议等障碍来改进护理的方法。同样，讨论还指出了护理模式如何利用原住民社区的优势，例如社会凝聚力和灵性。未来的步骤包括选择适当的绩效指标进行系统评估。确定这种护理模式的关键结构将有助于与患有慢性和复杂健康状况的服务不足人群的其他护理模式进行比较，并最终改善我们战士的护理状况。
American Indian and Alaska Native (AI/AN) veterans living in rural areas have unique health care needs and face numerous barriers to accessing health care services. Among these needs is a disproportionate prevalence of posttraumatic stress disorder and other mental illnesses. Since 2001, 14 rural communities have partnered with the U.S. Department of Veterans Affairs and the Centers for American Indian and Alaska Native Health at the University of Colorado Anschutz Medical Campus to extend telemental health clinics to American Indian veterans. Administrative and, to some extent, clinical considerations of these clinics have been reviewed previously. This paper describes a model of care, evolved over a 14-year period, that weaves together evidence-based Western treatment, traditional Native healing, and rural Native communities into 4 main components: mental health care, technology, care coordination, and cultural facilitation. We delineate improvements to care made by addressing barriers such as system transference, provider-patient trust, and videoconferencing. Similarly, the discussion notes ways that the care model leverages strengths within Native communities, such as social cohesion and spirituality. Future steps include selection of appropriate performance indicators for systematic evaluation. The identification of key constructs of this care model will facilitate comparisons with other models of care in underserved populations with chronic and complex health conditions, and eventually advance the state of care for our warriors.