**Author details**

In a subsequent study, these authors tested a more advanced telemedicine system, which in‐ cluded automated reminders to patients to send their data. Eighty GDM women were randomized to join an intervention group using telemedicine to send blood glucose record‐ ings obtained 4 times a day via the Internet or telephone, or a control group using paper log‐ books. Although there were no significant differences in the outcomes considered (glucose control and birth weight of offspring), this type of telemedicine approach improved the con‐ tact between patients and healthcare professionals, making the use of technology for moni‐

Finally, in GDM patients one study showed that integrating telemedicine applications and involvement of the nursing staff turns into better fetal outcome and adhesion to glucose monitoring. With this respect Ferrara et al demonstrated that higher referral frequency to telephonic nurse management for gestational diabetes mellitus decreased risk of macroso‐

Recent reports in the literature have addressed several aspects of telemedicine applied to the treatment of diabetes in pregnancy. The use of telemedicine appears to be not only feasible, but also capable of achieving the same glycemic control and perinatal outcomes as conven‐ tional care, with fewer visits to the clinic. This would naturally be appreciated by patients, but there is also the economic impact on the physician's side to consider. Fewer visits to the doctor would cut costs while assuring the same level of care, even after the costs of creating a telemedicine system have been taken into account. If telemedicine applied to the treatment of diabetes during pregnancy can benefit both parties (patients and doctors), it could drasti‐ cally change current treatment methods (ATTD 2010 Yearbook, 2011). The implementation of telemedicine in the clinical management of GDM also supports the greater involvement of figures, such as nurses and dietitians (Figure 1), whose support can help in saving time

The present review raises a number of questions about the intrinsic value of telemedicine in the management of chronic disease. It would be useful if future studies were designed very carefully in order to identify the true value of remote patient support systems. It would also be valuable to future reviewers if a minimum dataset were adopted to measure outcomes. Quantitative indices, from which pooled estimates of effect can be calculated, include:

toring of diabetes in pregnancy more familiar (Homko CJ, 2012).

**4. Conclusion**

70 Telemedicine

**•** cost to society;

**•** days in hospital.

**•** emergency department visits;

mic infant and increased postpartum glucose testing (Ferrara et al, 2012).

and resources in the follow-up of these patients (García-Patterson, 2003).

**•** quality of life (measured on scales appropriate to the diseases in question);

Nino Cristiano Chilelli, Maria Grazia Dalfrà and Annunziata Lapolla

Department of Medicine (DIMED), University of Padova, Italy

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**Chapter 5**

**Mental Health Services for California Native Americans**

The culture of the patient refers to a set of beliefs, norms, and values (Surgeon General Report (SGR) 2001). This affects symptoms, presentation, meaning, understanding, family issues, coping styles, treatment seeking, trust, stigma, and overall health status. A clinic and its clinicians also have a culture that affects communication and care. Native Americans continue to suffer disproportionately from a variety of illnesses and diseases, despite the funds for health care services, resulting in higher death rates (age 71, nearly 5 years below average) than the rest of the U.S. population (Office General Council 2004). Some of these disparities are directly related to, or significantly affected by individual behavior and lifestyle choices (Office General

The Office of the General Counsel and IHS outlined the causes of the disparities for Native Americans. Racial discrimination, which introduces unique emotional variables, has been noted (NIH 2001), and the Institute of Medicine established that whites are more likely to receive more thorough, diagnostic work and better treatment and care than people of color, even when controlling for income, education, and insurance (Vernellia Randall Institute of Racism 2002). Current research indicates that there are five, non-mutually exclusive, primary five primary contributors to disparities in health status and outcomes for Native Americans. For example, a person may arrive at a health facility only to find a lack of necessary services

> © 2013 Hilty et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 Hilty et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

distribution, and reproduction in any medium, provided the original work is properly cited.

**— Usual Service Options and a Description of**

**Telepsychiatric Consultation to Select Sites**

Donald M. Hilty, Peter M. Yellowlees, Nicole Tarui,

Steven R. Viramontes, Margo D. Kerrigan,

Additional information is available at the end of the chapter

**1.1. Culture and health disparities for Native Americans**

David L. Sprenger and Jay Shore

http://dx.doi.org/10.5772/56569

**1. Introduction**

Council 2004).

