Date of Graduation

Summer 8-8-2015

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers, PA-C, MS

Abstract

Background: Native American veterans compose a disproportionate amount of those who have served in the armed forces. Native veterans are more likely to be rural, have served in combat and have limited access to mental health services compared to other, non-Native rural veterans. Telemedicine may provide a unique modality which would increase access to health care and medication compliance. Although the use of telemedicine has been in place for over a decade with this population, its use is still limited and there is a dearth of studies on any long-term outcomes. Can the use of telemedicine mental health services increase access and medication compliance for Native American veterans in rural locations?

Methods: An exhaustive search of available medical literature was performed using Medline (Ovid and PubMed), CINAHL, Web of Science and PsycInfo using the following search terms: Native American, veteran and telemedicine. Relevant articles were assessed for quality using GRADE.

Results: Two studies reviewed met the inclusion criteria. A randomized trial in which 53 male Native American Vietnam veteran participants were administered the SCID (Structured Clinical Interview DSM) both in- person and via videoconferencing. Each participant completed the SCID using both modalities within a two week period. The assessment administered via videoconferencing provided accurate diagnostic information when compared to the in-person assessment. A retrospective, observational medical record and chart review was performed using the records of 85 male, Native American veterans. Information was gathered from before and after the patients’ first telehealth conference. The use of all health services by participants and psychotropic medication compliance increased after initial use of telemedicine services.

Conclusion: Access to mental health services increased with the introduction of telehealth services. Telemedicine is a valid treatment modality for mental health services and may be used to accurately diagnose patients who seek care. Additionally, telehealth services increased the use of prescribed, appropriate medication treatments for Native American veterans. Recommendations include the immediate expansion of telemedicine services, mental health and otherwise, for Native American veterans. More research needs to be done with multiple tribes with an emphasis on female veterans along with implications of telemedicine when mental health emergencies occur.

Keywords: Native American, veterans, telemedicine

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