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Implementation Considerations for Tribal Telehealth Programs

Many telehealth programs have focused on improving access to care for rural tribal communities, which can face persistent barriers to care related to geographic isolation and health workforce shortages. However, rural communities seeking to expand telehealth services to tribes should consider possible barriers to implementation, such as resistance to new technology.

One systematic review of telehealth programs serving tribal populations found that acceptance of telehealth technologies was a key barrier to program success. To address this challenge, rural telehealth programs should consider involving tribal leaders and patients during initial program development to ensure that the telehealth program will be accepted by and useful to participants. For example, this review describes how one telehealth program serving rural American Indian veterans with post-traumatic stress disorder adapted their program to feature family involvement in order to increase the acceptability of the program. Family members attended telehealth appointments with patients to offer support.

Another study of the diffusion of telehealth in VA-sponsored telehealth clinics for rural American Indians emphasized the importance of hiring staff who were aware of the cultural needs of the community. Rural communities seeking to serve tribes through telehealth programs should consider the importance of training and hiring clinical staff who are from the local community. In addition to clinical staff, rural communities could consider engaging community health workers to help patients address other needs outside of the healthcare setting.

The Indian Health Service's Telebehavioral Health Center of Excellence offers free continuing medical education credits to providers from rural and remote sites. For example, the on-demand IHS Essential Training on Pain and Addiction course focuses on best practices for safely prescribing opioids and other treatment options for chronic pain.

Resources to Learn More

Impact of Store-and-Forward Telehealth in Alaska: A Seven Year Retrospective
Document
Describes the outcomes of a store-and-forward telehealth program in Alaska. Describes the program utilization, benefits, potential areas for fraud and abuse, and barriers.
Author(s): Ferguson, A.S., Kokesh, J., Patricoski, C., Hofstetter, P., & Hogge, N.
Organization(s): Alaska Native Tribal Health Consortium
Date: 8/2009

Step-by-Step Guide for Setting Up Telebehavioral Health Services
Document
Serves a comprehensive step-by-step guide to set up telebehavioral services at a program site. Highlights the importance of health information technology staff and a telebehavioral health coordinator to the success of a program.
Organization(s): Indian Health Service: Telebehavioral Health Center of Excellence
Year: 2018

Telemedicine and American Indians in California
Document
Describes telehealth programs that serve American Indians in California. Includes case studies of telehealth in rural tribal communities.
Organization(s): California Telemedicine and eHealth Center
Date: 2005

The Success of Telehealth Care in the Indian Health Service
Document
Describes three successful telehealth initiatives in Indian Country. Highlights barriers and opportunities to better reach American Indian and Alaska Native populations.
Author(s): Hays, H., Carroll, M., Ferguson, S., Fore, C., & Horton, M.
Citation: Virtual Mentor, 16(12), 986-996
Date: 12/2014