The voices of the people: Lower Sioux Indian Community members speak out on what they need and want in a primary health care clinic on the reservation

摘要

American Indian/Alaska Native (AI/AN) people who live on reservations or in urban areas typically receive their health care in clinics that are operated by their tribe or are affiliated with Indian Health Service (IHS), a federal agency that provides care to AI/AN people. The Lower Sioux Indian Community (LSIC) is a federally recognized tribe located in southwest Minnesota near Morton, MN. LSIC members currently receive health care from outside providers at various locations near the reservation. The outsourced services include primary care, emergency care, hospitalization, surgery, dentistry, and podiatry. Because the providers are independent groups and do not work for the LSIC, continuity among health care providers is highly variable, as is the cultural awareness and competence necessary to provide high quality health care for AI/AN people. This often results in fragmented, episodic care as well as variation in levels of patient satisfaction with services. Transportation also poses an obstacle to care for LSIC members. The nearest health care provider is five miles from the middle of the LSIC.Compounding these issues for the LSIC and other tribes are the tremendous health disparities between AI/AN people and U.S. population averages. Diseases such as diabetes and cancer are rampant among the AI/AN population and require ongoing, coordinated primary care. Deterring such diseases or minimizing their devastating effects requires a major paradigm shift to wellness and prevention. The use of primary care services that feature a more local, patient-centered medical home (PCMH) may help improve health outcomes. A PCMH emphasizes care that is coordinated, connected, and communicated in ways that ensure it is being provided as the patient wants.The LSIC has secured funding through its gaming operations and a commercial bank loan to build a new health care clinic within the community. Tribal elders have been hearing from tribal members who want to be involved with operations and care delivery. The building will be located close to the tribal government center and children’s play area. Because it is on tribal land, there is no cost to purchase the land or taxes to be paid. IHS resources will include environmental, biomedical, and recruitment services. The approximately $5 million facility was scheduled to break ground in spring 2015, with a projected opening in fall 2015.This building project presented a golden opportunity to include the voices of the people in planning for the new primary health care clinic, in hopes of improving patient satisfaction and outcomes. This DNP project involved a qualitative case study using focus groups to discuss what LSIC members want in their clinic and how they would like to be cared for. The project involved several small focus groups that were asked open-ended questions while dialogue was recorded. The results helped determine the most appropriate, culturally competent health care delivery model for providers and staff to use in the new clinic. The value of this project is significant to the LSIC as well as to other tribes in the Midwest that are considering building or expanding health care services within Indian country.