Primary Care Utilization in Native American Communities: Challenges and Opportunities

Context: American Indian/Alaskan Native (AI/AN) patients are disproportionately affected by deleterious health outcomes for many preventable disease when compared to their non-indigenous counterparts. It is paramount to understand the barriers faced by the AI/AN community to better serve their medical needs. The impact of long-standing inadequate access to basic healthcare coupled with generational trauma has contributed to community distrust of western medicine.

Objective: By investigating the utilization of primary care resources, the authors hope to assess the efficacy of current approaches, better inform future public health initiatives, and improve health outcomes in this medically marginalized community.

Study Design and Analysis: A systematic literature review of PubMed, CINAHL and SCOPUS. Included articles were published in English-language peer reviewed journals from 1978 until 2023. Articles that focused on AI/AN populations were sorted under three hypotheses, then identified as supporting, not supporting, or discussing nuance of their hypothesis.

Setting or Dataset: Articles published in English-language peer reviewed journals from 1978 until 2023.

Population Studied: AI/AN patients residing in the USA.

Intervention/Instrument: Included articles addressed: condition prevalence, perceived need for treatment, health service utilization, alternative medicine usage, perceived barriers to obtaining care, perception of health care providers, lifetime experience of racial discrimination, and historical trauma on patient decision-making.

Outcome Measures: Articles were analyzed and sorted under three hypotheses and identified as supporting, not supporting, or discussing nuance of the hypothesis.

Results: All hypotheses were supported. AI/AN patients utilize primary care resources at a lower rate than their non-AI/AN counterparts. Greater degrees of cultural competence demonstrated by the medical care team were associated with higher rates of AI/AN patient utilization of primary care services. Greater efforts by the medical care team to facilitate patient access to healthcare were associated with higher rates of primary care service utilization.

Conclusions: Administering comprehensive, culturally competent preventive care in AI/AN communities has the potential to improve outcomes by increasing patient engagement but will require a commitment to integrating historical and cultural practices in everyday patient care.