LITERATURE REVIEW
Integrated Care with Indigenous Populations: Considering the Role of Health Care Systems in Health Disparities
Melissa E. Lewis, PhD, LMFT Laurelle L. Myhra, PhD, LMFT
Abstract: Introduction. There is increased evidence for the effectiveness of integrated behavioral health care, however, it is unknown if integrated care is effective or culturally appropriate for Indigenous populations--the population with the largest health disparities in the nation. Methods. We conducted a literature review to analyze the state of Indigenous health care focusing specifically on the appropriateness of integrated care in this population. Results. Integrated care could improve access to comprehensive care, quality of care, and may be a promising model to reduce health disparities for Indigenous people. Discussion. Indigenous people experience significant barriers to effective health care services that require strategic, systemic, and collaborative interventions to close these gaps. Integrated care appears to be an appropriate solution but additional research is needed to determine this. Further, any health intervention must be carried out in collaboration with tribal com- munities and nations to ensure success.
Key words: Integrated care, primary care, systems of care, Native American, Indigenous, American Indian, health disparities.
Shere is a growing body of evidence regarding the effectiveness of integrated care,1,2 I however, it is unclear how effective or culturally appropriate integrated care is for racial and ethnic minority populations3--specifically, Indigenous populations.* Inte- grated care is the coordination of health care through a holistic approach, and for the purpose of this paper, the use of behavioral health interventions within medical care.4 Compared with all other racial/ethnic groups in the United States (U.S.), Indigenous
* We use the term Indigenous to refer to the Native people of North America (United States and Canada) (otherwise known as First Nations, Native American, Alaskan Native and Native Hawaiian). We under- stand the complexity and political implications for the use of labels and do not wish to perpetuate insen sitivity of many of these labels and recommend that local and regional terms be used when possible. In addition, the word Indigenous will be capitalized to indicate that it is representing a population group
MELISSA E. LEWIS is affiliated with the Department of Family and Community Medicine at the University of Missouri School of Medicine in Columb ia, Missouri. LAURELLE L. MYHRA is the Director of Behavioral Health, Native American Community Clinic, 1213 Franklin Ave, Minneapolis, MN 55404 Imyhra@nacc-healthcare.org. Please address all correspondence to Melissa Le wis, PhD, LMFT, University of Missouri, MA301 Medical Sciences Building DC032.00, Columbia, MO 65212; Fax: 218-726-7559; E-mail: lewismeli@health.missouri.edu.
@ Meharry Medical College Journal of Health Care for the Poor and Underserved 29 (2018): 10831107.
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people suffer from the largest mental health, substance use, and physical health dis- parities.5,6 The health care settings with the largest minority populations tend to be the lowest-performing practices, clinics, and hospitals.7,8 Further, a review of health care quality discovered that "significant disparities in the quality of health care for AIANs (American Indian/Alaskan Natives) exist in all dimensions of qualit