Northwest Portland Area Indian Health Board: Indian Leadership for Indian Health

History & Goals

Background
Methamphetamine use and its production have become an epidemic in tribal communities across the country.  It has resulted in increased costs in an already financially stressed social and
economic system.
According to a recent study, treatment admission of persons with primary methamphetamine use problems increased from 21,000 to 117,000 in 2003.  In 2004, 1.4 million persons aged 12 or older had used methamphetamine in the past year and 600,000 had used methamphetamine in the past month.  These two groups represent a little less than 1 % of the total US population.
In 1997, the Indian Health Service (IHS) began collecting methamphetamine patient encounter data. The first year, the Agency reported 31 patient visits that were methamphetamine related.  In 1998, methamphetamine related visits increased by 1,877% to 613 in a single year.  While this increase may be a result of better data availability, the longitudinal trend shows longitudinal increases in methamphetamine related visits.
American Indians and Alaska Natives suffer health disparities at a higher percentage than other racial/ethnic groups in the United States for many diseases, including mental health issues,
suicide, risk for HIV/AIDS and Hepatitis B and C.  Those in the teen years to middle aged adulthood seem to have the highest rates of methamphetamine use. 

While the issues around methamphetamine continues to escalate.  The actual scope of the effects of methamphetamine remains an unknown for most tribal communities and as well as the dynamics and effects of methamphetamine use among all AI/AN populations.  This is due to an overall lack of data collection surrounding these issues.  The National Survey on Drug Use and Health Report (Sept. 24, 2004) notes increased rates of substance use among AI/ANs compared with persons from other racial/ethnic groups.  The Substance Abuse Mental Health Service Administration’s (SAMHSA) Treatment Episode Data Set, moreover, indicates a substantial increase of admissions for methamphetamine treatment (SAMHSA, TEDS 1999).  Further, none of the National Institutes for Drug Abuse Clinical Trials Networks have addressed treatment for methamphetamine dependence.  Data on the prevalence of methamphetamine use and abuse among AI/ANs is limited and needs to be improved to develop comprehensive, effective programs.

This Initiative is designed to begin to establish data bases and an information repository about the effects of methamphetamine for the tribes in the Northwest.  Currently there are no such data bases and limited ease of access to existing knowledge about AI/AN issues regarding the impact of methamphetamine in tribal communities and AI/AN populations.

Objectives
Objective 1: To define objective data elements available in the IHS Resource Patient Management System (RPMS) and similar data systems, such as Veteran’s Administration and health maintenance organizations.

  • To explore data quality and identify barriers to effective data availability.
  • To develop strategies for data improvement in the RPMS system to allow effective evaluation of methamphetamine use/abuse in Indian Country.

Activities: An initial data analysis of information availability in RPMS will be conducted. Following this analysis, data quality and availability will be explored.  The RPMS system will be utilized to identify patient contacts that are coded as methamphetamine related, drug and alcohol related, drug treatment related, prevention and education related.  This query will involve aggregate data and analysis.  Information will be made available to each respective tribe, but the final report will not divulge any association with any specific tribe.  Data will be presented by IHS region as the analytical unit.  A more in-depth collection of data will occur with each of the tribes and urban programs in the Northwest Portland Area.  Information will be requested from each of the tribes and IHS urban programs in the Northwest Portland Area that is not part of the RPMS reporting requirements.  The nature of this data is currently unknown as to possible context, reliability, or homogeneity.  All information and data collected will be treated with the same precautions as the RPMS data.  Barriers to data availability will be examined.  Comparison of data element availability will be made to other national and/or local large health care organizations.  A verbal survey of available data elements will be undertaken.  Following exploration of data barriers within the RPMS system and comparable systems, key strategies for data improvement will be explored.  This will be presented to RPMS national staff and to the Association of American Indian Physicians (AAIP) in writing no later than the third quarter of the project year.

Objective 2: Coordinate with the United South & Eastern Tribes (USET) organization with regard to national survey development and implementation.

Activities: Act as lead agency to pilot questionnaire in NPAIHB region and with NPAIHB partners in the Methamphetamine Initiative. Test validity of questionnaire.

Objective 3: To identify current treatment service availability, referral, and use by AI/AN populations by the end of the first project year.

Activities: During the data collection phase of the project, current effective prevention and treatment models will be identified.  Appropriate protocol will be followed to acquire permission, from respective governing bodies to report these case studies for program development/replication in other communities.  Qualitative assessment of the components of these models will be performed using content analysis of programmatic materials.

A written analysis of best practices will be presented for inclusion in the methamphetamine tool kit by the end of the third quarter of the project year.

Objective 4: To review products for methamphetamine tool kit.

  • Develop a logic model for data analysis to use in Indian Country by the end of the first year.
  • Develop analytical model for RPMS query and description of RPMS for tool kit.
  • Develop representative review committee of NPAIHB board delegates to provide tribal review for tool kit.

Activities: An analysis from the data and current effective programs will be transformed into a logic model for guidance for development or evaluation of methamphetamine issues and programs in other Indian communities.  By the end of the first quarter of year 1 a five member review committee of NPAIHB board delegates will be appointed to review the methamphetamine tool kit.  Review project materials to be used at the local tribal level by the end of the third quarter