Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review

Abstract

Background Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. Methods We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? Results We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. Discussion: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. Conclusion These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.

Urgent versus elective surgical disparities among American Indian and Alaska Native patients

“…Although implementation of telehealth is not without its challenges, the flexible formats for telemedicine consultations, including smartphone apps, could further facilitate access to preventive care. 17 Washington State regulations are moving in this direction, with the establishment of full billing parity for remote tele-visits and in-person appointments, in the course of the COVID-19 pandemic. 9 Our study has several limitations.…”

“…Clinicians based in IHS or tribal clinics could be recruited for telemedicine programs that would allow access even when the patient was physically distant from the point of care. Although implementation of telehealth is not without its challenges, the flexible formats for telemedicine consultations, including smartphone apps, could further facilitate access to preventive care 17 . Washington State regulations are moving in this direction, with the establishment of full billing parity for remote tele‐visits and in‐person appointments, in the course of the COVID‐19 pandemic 9…”

Knowledge Is (Still) Key: Awareness to Shape Trends in Telemedicine Use during the Pandemic Based on Management Perceptions and Implementation Systems

“…One study stated that telehealth investments could increase the utilization of youth health services and help maintain relationships with adolescents during shocks, including during a pandemic or other conditions that can limit physical access to health services [ 33 ]. The success of any use of new technology in the health sector depends on the user's knowledge, perception, and skills regarding the concept of program implementation [ 41 ]—digital skills of health workers and skills of patients [ 33 ]; attitude; and environment [ 40 ]; physical limitations of the patient; patient's cognitive limitations; sociodemographic and clinical characteristics of patients [ 34 ]; limitations of service provider diagnosis and management; perception of high costs (especially for mental health services) [ 32 ]; and language barriers [ 42 ]. There are specific legal, cultural, and social challenges [ 43 ].…”