Public Health and Indigenous Peoples: North America, Australia, and New Zealand

Greenwood, Margo; Halseth, Regine; Lindsay, Nicole; McGregor, Hilary; Leeuw, Sarah de; Atkinson, Donna; Keahey, Deborah

doi:10.1093/obo/9780199756797-0071

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This strategy was designed with community stakeholder input to meet community needs and address unique Indigenous determinants of health . Cardiovascular health disparities among American Indian and Alaska Native people are due to the enduring impacts of settler colonialism; 1 in 3 people living on the Navajo Reservation lack running water or electricity, and significant access issues include lack of paved roads and transportation . IHS sites are chronically underfunded by the US government, and specialty access is limited .…”

Section: Discussionmentioning

confidence: 99%

Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation

Eberly,

Tennison,

Mays

et al. 2024

JAMA Intern Med

View full text Add to dashboard Cite

ImportanceUnderutilization of guideline-directed medical therapy for heart failure with reduced ejection fraction is a major cause of poor outcomes. For many American Indian patients receiving care through the Indian Health Service, access to care, especially cardiology care, is limited, contributing to poor uptake of recommended therapy.ObjectiveTo examine whether a telehealth model in which guideline-directed medical therapy is initiated and titrated over the phone with remote telemonitoring using a home blood pressure cuff improves guideline-directed medical therapy use (eg, drug classes and dosage) in patients with heart failure with reduced ejection fraction in Navajo Nation.Design, Setting, and ParticipantsThe Heart Failure Optimization at Home to Improve Outcomes (Hózhó) randomized clinical trial was a stepped-wedge, pragmatic comparative effectiveness trial conducted from February to August 2023. Patients 18 years and older with a diagnosis of heart failure with reduced ejection fraction receiving care at 2 Indian Health Service facilities in rural Navajo Nation (defined as having primary care physician with 1 clinical visit and 1 prescription filled in the last 12 months) were enrolled. Patients were randomized to the telehealth care model or usual care in a stepped-wedge fashion, with 5 time points (30-day intervals) until all patients crossed over into the intervention. Data analyses were completed in January 2024.InterventionA phone-based telehealth model in which guideline-directed medical therapy is initiated and titrated at home, using remote telemonitoring with a home blood pressure cuff.Main Outcomes and MeasuresThe primary outcome was an increase in the number of guideline-directed classes of drugs filled from the pharmacy at 30 days postrandomization.ResultsOf 103 enrolled American Indian patients, 42 (40.8%) were female, and the median (IQR) age was 65 (53-77) years. The median (IQR) left ventricular ejection fraction was 32% (24%-36%). The primary outcome occurred significantly more in the intervention group (66.2% vs 13.1%), thus increasing uptake of guideline-directed classes of drugs by 53% (odds ratio, 12.99; 95% CI, 6.87-24.53; P &lt; .001). The number of patients needed to receive the telehealth intervention to result in an increase of guideline-directed drug classes was 1.88.Conclusions and RelevanceIn this heart failure trial in Navajo Nation, a telephone-based strategy of remote initiation and titration for outpatients with heart failure with reduced ejection fraction led to improved rates of guideline-directed medical therapy at 30 days compared with usual care. This low-cost strategy could be expanded to other rural settings where access to care is limited.Trial RegistrationClinicalTrials.gov Identifier: NCT05792085

show abstract

Section: Discussionmentioning

confidence: 99%