Wednesday, September 1, 2010

Telemedicine Helps Native Americans

The University of California, Davis School of Medicine is using grant funding to train Native American communities in the state. The training sites include the Round Valley Indian Tribes of Covelo, Mendocino County, and communities served by Northern Valley Indian Health Inc. that includes Glenn County and portions of Butte, Tehama, and Colusa.

The goal is to decrease obesity and type-2 diabetes in the Native American population through a $1 million research grant from NIH’s National Institute of Diabetes and Kidney Diseases. The researchers plan on collaborating with community members to teach them how to perform research on their own communities and to make certain that the research is culturally appropriate.

Specifically, the two year research initiative will train community members on using community-based and community-governed participatory research techniques. The UC Davis researchers will work with two established community health centers such as the Round Valley Indian Health Center and the Northern Valley Indian Health Inc.

Over one third of all American Indian adults nationwide are obese, compared with about 22 percent of non-Hispanic whites. Among the Native American communities participating in the study, nearly 68 percent of adults are obese and 24 percent of children between 2 and 5 years old have body mass indexes in the 95th percentile for their ages. American Indians are 2.6 times as likely to be diagnosed with diabetes as non-Hispanic whites.

Telemedicine will be used through the UC Davis Center for Health and Technology that uses real-time video conferencing to provide education and group interaction as well as specialist and subspecialist consultation for patients and physicians in remote rural areas throughout the state. James Marcin, Professor of Pediatrics, and Director of the UC Davis Pediatric Telemedicine Program will direct the work.

An important aspect of the research according to Dennis Styne, study principal investigator and the Yocha Dehe Endowed Chair in Pediatric Endocrinology is the development of the Nor Cal Tribal Institutional Review Board to review and approve research projects needed by these communities. This work will be supported by the UC Davis Health System Institutional Review Board.

In Oregon, ophthalmologists from the Legacy Good Samaritan Devers Eye Institute in collaboration with researchers at Oregon Health & Science University (OHSU) are using telemedicine to help treat Native Americans hundreds of miles away in Pendleton Oregon and in Wichita Kansas. The medical community hopes to help underserved patients in these areas not lose their eyesight to complications of diabetes.

Less than 50 percent of Native American Diabetic patients receive annual eye exams. Only two of the 43 federally recognized tribes in the Pacific Northwest have affiliated clinicians who can provide yearly eye exams. The long distances between many rural reservations and urban eye care centers complicate providing routine care. Telemedicine has a large potential to help in these remote areas.

OSHU’s Center for Healthy Communities, a Prevention Research Center funded by CDC for the past 6 years has been collaborating with the Legacy Devers Eye Institute and the Northwest Portland Area Indian Health Board. Together, the institutions have initiated vision screening and eye exams in multiple tribal communities and have found a high prevalence of patients with undiagnosed glaucoma as well as diabetic retinopathy.

OSHU and Legacy Devers Eye Institute are using a HIPAA-compliant, secure, store-and-forward web-based telemedicine system that uses non-mydriatic cameras to capture images of the retina and optic disc.

Community-based research assistants in Pendleton and Wichita photograph diabetic patients’ eyes and transmit the images electronically to Legacy Devers for reading and diagnosis. OSHU researchers serve as the administrative hub for the projects, providing data analysis and then evaluate the program to measure its efficiency and long term sustainability.

OSHU’s involvement in the project made it possible for the program to win a $2 million grant from CDC since OHSU is a member of the CDC’s Prevention Research Center Program. This grant funding will be used to determine the effectiveness of telemedicine in detecting the progression of diabetic retinopathy as compared with traditional annual eye exams in a physician’s office.

Other goals include:

• Developing and refining the “Compliance with Annual Diabetic Eye Exams Survey” to determine the factors related to adherence with annual eye exams by using telemedicine and also traditional surveillance methods

• Estimating the cost effectiveness of a telemedicine system from the perspective of both the provider and the individual patient

The data obtained from the project will be presented to legislators to provide the framework for changes in national and statewide guidelines.