Healthcare Partnerships in Rural Alaska

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Healthcare Partnerships in Rural Alaska

• Harry Ko, D.O., CDR, USPHS
• Heather Skelton, R.N., LCDR, USPHS

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Objectives

• Review Alaskas unique medical delivery system
  for rural villages
• Describe the interactions between village
  providers and referral sites
• List the barriers, obstacles, and positive
  outcomes related to partnerships with rural
  healthcare providers

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Community Health Aid/PractitionerAlaska Tribal
Health Compact

• Alaska has 229 federally recognized tribes and
  some 130,000 Alaska natives. About 85,000 of
  those people live in rural Alaska.
• The Alaska Tribal Health Compact links 39 tribal
  health organizations with each other and the
  federal government in providing tribally managed
  health care through the Indian Health Service.
• Included in the system are the Alaska Native
  Medical Center (a statewide referral and tertiary
  facility in Anchorage), six regional hospitals
  and clinics in some 200 rural communities across
  the state.

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Community Health Aid/PractitionerHistory

• Federal Program unique to Alaska and the Indian
  Health Service- established 1968.
• This distinct health care delivery system was
  developed as a solution to combat problems unique
  to Alaska. Began with the tuberculosis epidemic
  of the 1950s when volunteer chemotherapy aides
  gave out medications in the villages.
• Community Health Aide Program Certification Board
  (CHAPCB) maintains CHA/P training and practice
  standards and policies. They certify CHA/Ps,
  Dental Health Aides, and CHAP Training Centers.
• Certification Board standards available at
  www.akchap.org

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Community Health Aid/Practitioner Selection and
Training

• CHAs are hired by the local Tribal Health
  Organization and then trained.
• After hire, 1-2 week Pre-Session training from
  their employer and Emergency Trauma Technician
  Training (ETT).
• CHAP Basic Training Four Sessions, each 3-4
  weeks long at a certified Training Center in
  Alaska over a 2 year period. CHAs return to
  their villages between Sessions.
• Basic Training is focused didactic classes,
  skills practice, and clinical time (one-on-one)
  with an instructor. All training emphasizes the
  use of the Alaska Community Health
  Aide/Practitioner Manual (CHAM).

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Community Health Aid/Practitioner Physician
Supervision

• Physician supervisors have the legal
  responsibility for the care provided by the
  CHA/P.
• Scope of practice is defined by the Community
  Health Aide Manual (CHAM)
• Physicians must ensure each CHA/P utilizes the
  CHAM since it contains patient care plans which
  reflect best practice recommendations and allows
  the physician to use as standing orders.
• Medical Standing Orders (MSO)

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Community Health Aid/Practitioner Telemedicine

• AFHCAN Alaska Federal Health Care Access Network
• Unique collaboration of federal agencies (VA,
  DoD, USCG, DOT, IHS, and the Alaska Native Tribal
  Health Consortium (ANTHC)) for the purpose of
  providing healthcare to over 300,000 federal
  beneficiaries in the State of Alaska.
• PickPoint automated pharmaceutical storage and
  dispensing
• Digital Radiology
• Field Consultation
• Internet communication by CHA/P and patients

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AFHCANAlaska Federal Health Care Access Network
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PickPoint
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Village Visit

• First rule CHA/Ps are the primary care providers
  for the village.
• Second Rule You cant fix everything and you
  have limited resources.
• See patients with the CHA/P.
• CHA/P and/or Community Education
• CHA/P chart reviews

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Community Health Aid/Practitioner Role of Nurses
During Village Visits

• Visit preparation Coordinate patients to be
  seen, immunization update, equipment, forms
• Assist with patient care
• Process referrals and coordinate follow-up in
  Anchorage
• Home visits, patient education, staff training

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Community Health Aid/Practitioner Role of Nurses
for Patient Care in Village

• Triage as Patient Encounter Forms (PEF) are
  submitted or CHA/P call Anchorage
• Facilitate appropriate medical response based on
  triage Emergent/Urgent/Routine response
• Coordinate travel arrangement requests based on
  referral appointments and any needed diagnostic
  testing

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Community Health Aid/Practitioner Role of Nurses
for Village patient in Anchorage

• Appropriate follow-up on referrals and
  diagnostic/screening test results
• Assist with last minute appointments or changes
  in schedules
• Coordinate services which are not available in
  the village

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Goals of Partnerships with Rural Healthcare
Providers

• Access to appropriate medical care to improve
  overall health and well being.
• Support rural Alaskans in maintaining their
  traditional way of life.
• Control of healthcare expenses.

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Barriers/Obstacles to Partnerships with Rural
Healthcare Providers

• Geography
• Communication breakdown
• Staffing Limited availability of consistent
  providers in rural clinics coupled with frequent
  staff changes in Anchorage.
• Unrealistic expectations

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Positive Outcomes of Partnership with Rural
Healthcare Providers

• Ready access to medically trained personnel to
  perform basic medical examinations and provide
  appropriate treatment.
• Strengthening relationships
• Patient-CHA/P-Physician/Nurse
• Village/Tribal Organization-ANTHC
• Continuity of care.
• Improved patient compliance.

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