Download this article from Academic Pharmacy Now: Oct/Nov/Dec 2011: Indian Health Service and Academic Pharmacy
Improving the health of Native Americans and Alaska Natives (NAAN) has never been more important. Native Americans and Alaska Natives continue to have some of the greatest disparities in health status compared to the general U.S. population. Infant mortality, chronic illness, mental health disorders and substance abuse are more prevalent among Native Americans and Alaska Natives compared to any other population group in the United States. A lack of culturally appropriate care, distance to healthcare sites, lack of transportation, poor access to prevention and wellness programs, and a continuing shortage of health professionals are some of the reasons this disparities gap exists. For several decades now, pharmacists have played an integral role in care delivery in Indian Health Service (IHS) facilities. In fact, since 1966 all new IHS facilities have been built with individual, private counseling rooms. The teambased approach to care within the IHS that included the pharmacist continues to serve as a model for improved quality of care in other healthcare systems.
To address these gaps, the Indian Health Service (IHS) was established in 1955 as a part of the U.S. Public Health Service and both are units of the Department of Health and Human Services. Today, the IHS is an organization that provides direct care services as well as supports tribes through public health research and program evaluation through its epidemiology centers. There are nearly 2 million individuals that identify themselves as Native American or Alaska Native. Much of their healthcare needs are met by services provided at IHS facilities, facilities contracted through IHS to provide care and tribally-supported facilities. While increases in facilities and improved access continue, the current funding level of $4.05 billion in FY10 meets just over 50 percent of the actual care needs of this wide-spread population. In fact, per capita healthcare spending for Native American and Alaska Natives is not quite half of what the average is for all Americans. The IHS works diligently to improve the quality of care and quantity of care to which Native Americans and Alaska Natives have access. An increased focus on prevention and wellness, provider support through telemedicine programs and collaborations with health professions organizations and institutions are helping close the disparity gaps.
Yet, with all the increased budgets, facility improvements and use of technology vacancy rates for health professionals to provide care continue to remain high. Over the last decade, pharmacy education has worked closely with the IHS and increasingly with tribal governments to improve the quality of care for Native Americans and Alaska Natives. This close working relationship has created the opportunity for two IHS supported programs in particular to play a significant role in reducing the vacancy rates for pharmacists. The IHS pharmacy residency training program is now recognized as an important program not just for the development and training of advance practice pharmacy professionals but also for the development of strong, competent organizational leaders. There are currently 18, ASHP-accredited, pharmacy residency sites within the IHS.
One of the most important programs that helps improve provider, including pharmacist, recruitment and retention is the IHS loan repayment program. This program provides payment of up to $20,000 per year for a two-year commitment to practice full-time at an IHS site. While the vacancy rate for pharmacists is currently 11 percent, it continues a downward trend as more funds are available to support the loan repayment program. During the early years of this decade, pharmacists were among selected providers deemed by Congress as high priority recipients of loan repayment.
Students interested in a career in the U.S. Public Health Service as a commissioned officer that can be placed in an Indian Health Service facility should consider participating in the Junior and Senior Commissioned Officer Student Training and Extern Program (COSTEP). The Junior COSTEP is an excellent way to gain exposure to the Commissioned Corps which can assist with determining whether this is an appropriate career path. If it is, the Senior COSTEP will help prepare you for that career. Both programs, like the residency and loan repayment programs, are highly competitive but provide a lifetime of benefit.
William G. Lang is Vice President of Policy and Advocacy at AACP; firstname.lastname@example.org.
Organizational Foundation of the Indian Health Service
(From the Indian Health Service Web site.)
For general information about the IHS go to: http://www.ihs.gov
For general information about the IHS pharmacy program go to: http://www.ihs.gov/pharmacy/
For information about the IHS loan repayment program go to: http://www.ihs.gov/JobsCareerDevelop/DHPS/lrp/
For information about the IHS pharmacy residency program go to: http://www.ihs.gov/medicalprograms/pharmacy/Resident/
For information about the Junior and Senior COSTEP programs go to: http://www.usphs.gov/student/COSTEP.aspx