Neurological Care within the Indian Health Service.

Area of Science:

• Health Services Research
• Neurology
• Indigenous Health

Background:

• American Indians and Alaska Natives (AI/AN) are Indigenous peoples of the U.S. with diverse cultures and histories.
• Treaties with the U.S. government established commitments for healthcare, leading to the Indian Health Service (IHS).
• AI/AN populations, particularly those in rural or remote areas, experience significant barriers to accessing specialized neurology care.

Purpose of the Study:

• To review 40 years of neurology care provision within the IHS.
• To make recommendations for initiating sustainable neurology care in marginalized AI/AN populations.
• To discuss the IHS, its neurology care models, and neurological conditions prevalent in AI/AN communities.

Main Methods:

• Review of historical neurology care provision within the Indian Health Service (IHS).
• Analysis of healthcare delivery models, including midlevel provider extension and traditional medical care.
• Examination of select neurological diagnoses within AI/AN populations.

Main Results:

• The IHS provides healthcare to approximately 2.7 million AI/AN across 574 federally recognized Tribes in 37 states.
• Novel solutions have been developed by the IHS to improve access to specialty care, including neurology.
• Initial investments in full-time, on-site neurology providers have demonstrably improved the robustness of neurology care within the IHS.

Conclusions:

• Stable, on-site full-time neurology services are crucial for establishing sustainable neurology care in marginalized populations.
• The IHS model demonstrates a viable pathway for other underserved communities to improve access to specialized neurological services.
• Continued investment and strategic implementation of neurology services are essential for addressing healthcare disparities in AI/AN populations.