通过有效的医疗系统导航，改善美国原住民老年人获得和使用医疗保健的机会。
"Improving Native American elder access to and use of health care through effective health system navigation".
机构信息
Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque, NM, 87106, USA.
Department of Anthropology, University of New Mexico, MSC01-1040, Anthropology 1, Albuquerque, NM, 87131, USA.
出版信息
BMC Health Serv Res. 2018 Jun 18;18(1):464. doi: 10.1186/s12913-018-3182-y.
BACKGROUND
Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.
METHODS
This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.
DISCUSSION
The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.
TRIAL REGISTRATION
This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.
背景
过去二十年的公共保险改革未能实质性地满足美国印第安人的医疗保健需求，更不用说满足 55 岁及以上的美国印第安老年人的特殊需求了。从历史上看，与所有其他美国老年人口相比，这一人群更有可能没有保险，并患有更多的疾病，健康状况和生活质量更差，预期寿命更低，是医疗保健系统中被忽视的群体。尽管人们普遍认为美国印第安人服务局将满足他们所有与健康相关的需求，但美国印第安老年人因保险差距和获得医疗保健的机会有限而受到负面影响。虽然 2010 年《病人保护与平价医疗法案》包含了改善美国印第安人差异的条款，但该法案的未来仍不确定。在这种情况下，健康素养参差不齐的美国印第安老年人必须在无论他们在哪里寻求医疗服务，都必须在复杂且不稳定的医疗保健系统中进行导航。
方法
本社区驱动的研究采用混合方法、参与式设计，以检查新墨西哥州美国印第安老年人的寻求帮助行为和医疗保健体验，以便制定和评估一项定制干预措施，以增强他们对保险和可用服务的了解、获得和使用，从而减少医疗保健差距。这项研究包括对美国印第安老年人和其他利益攸关方进行定性和定量访谈，并结合概念映射和焦点小组。
讨论
收集的信息将产生新的实践知识，这些知识建立在美国印第安老年人和其他相关利益攸关方的实际观点基础上，以改善医疗实践和政策，使这一长期被排除在国家和州医疗改革讨论之外的人群受益。研究数据将为制定和评估文化适应性方案提供信息，以增强美国印第安老年人对不断变化的医疗保健格局的理解，并促进他们对这一格局的谈判。这项工作将填补公共保险计划研究的空白，这些计划通常不关注这一人群，并将为增强此类计划对受医疗保健不平等影响的其他服务不足群体的效果提供一个可复制的模式。
试验注册
本方案不包括健康结果数据的收集。Clinicaltrials.gov，NCT03550404。注册于 2018 年 6 月 6 日。
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