Levelling the playing field
Improving diabetes care for Alberta’s First Nations communities through technology
Aug. 19, 2016
Dr. Dean Eurich
According to a 2011 Public Health Agency of Canada report, rates of diabetes in some First Nations communities have reached epidemic levels.
“Diabetes rates in First Nation communities are three to five times higher than the general Canadian population, a situation compounded by barriers to care for Aboriginal people,” says Dr. Dean Eurich. “Limited community nursing capacity, isolated environments and a lack of electronic health records lead to a reactive and disorganized approach to diabetes care for First Nations people.”
To address this, a study jointly funded by AIHS and CIHR under the eHIPP (see sidebar) program is being led by Dr. Eurich at the University of Alberta. Dr. Eurich’s study will use technology to improve the coordination of care of diabetic patients in First Nations and isolated communities to bring it more in line with the care being provided in larger urban centres.
In urban centres, a visit to your physician means critical health-related information such as your blood pressure, cholesterol levels, blood sugar levels, and results from foot and eye exams is entered into an electronic health record. Some of this information might result in a flag for follow up in six months or maybe a year, which allows health care professionals to monitor conditions like diabetes. This is not the case on reserves, where access to electronic health records is limited and where care is led mostly by front-line nurses or, more commonly, by a community health representative who does not have significant medical training.
“Currently, few, if any, First Nation communities have the infrastructure, expertise, or resources to employ the five Rs of diabetes care, particularly the ability to systematically identify and track diabetes patients and share their vital health information seamlessly,” says Dr. Eurich.
His study called RADAR—Reorganizing the Approach to Diabetes through the Application of Registries—will use a shared platform called the Community Assessment Response, and Empowerment—CARE—platform.
“The CARE platform combines a client registry and electronic clinical chart for clients across three traditionally distinct and segregated programs responsible for care on reserves. This includes Home and Community Care, Aboriginal Diabetes Initiative, and Community Health,” says Dr. Eurich.
The CARE platform, accessed online through a web portal, will allow users to register all patients with diabetes in a community and document their health, but it is not enough to provide a resource without also providing someone to use it.
“We knew these communities would need someone to help coordinate care.” says Dr. Eurich. “But there are over 50 First Nations communities in the province and it’s not feasible to hire a nurse to be in each one. There aren’t enough dollars, so we started to think of a way where we can do it effectively in a sustainable way, and we came up with the idea of the CARE coordinator.”
Kari Meneen is the CARE coordinator for the study. Her role is the pivotal link between the care team in the community and the CARE platform. “This study will be very valuable,” she says. “As a nurse, something I’ve always felt that was missing in rural communities is an electronic health record. With access to the CARE platform, care givers on site will be able to provide better care that’s not as fragmented. They won’t feel like they’re missing pieces of vital information. I’ll help them to first identify their community’s diabetes population, and then develop interventions.”
Kari will start by looking at all the existing patient records and identifying those who haven’t had specific checkups recently. This information will help care givers know who is at risk of more serious issues. She will then work with either the community health centre, or the physicians to coordinate and address services.
“Most people don’t realize how fractured care is in these communities,” says Dr. Eurich. “Kari will help broker conversations between communities.”
“I have a strong interest in trying to improve outcomes in people with diabetes. Whether they are on-reserve, or off-reserve,” says Eurich. “It also interests me to see if we can start to use technology to move not just individuals, but populations in the direction that we want in terms of their health and health outcomes as well. If we could prove that this works for diabetes, there is no reason this wouldn’t work in any number of other chronic conditions.”
Funding for this study – eHIPP
AIHS has matched funding for the eHIPP program.
Okaki, a Canadian-based technology company, also matched the eHIPP investment. In addition, they developed and are managing the study’s CARE platform.
See Dr. Dean Eurich talk about the RADAR program.
Drs. Dean Eurich and Raj Padwal were the two Alberta researchers to be awarded the eHIPP grant.
Meet the research lead
Dr. Dean Eurich, a clinical pharmacist by training, is an Associate Professor in the School of Public Health at the University of Alberta. His focus is primarily in clinical epidemiology, including health services research, some clinical trials, and quality improvement implementation-type studies. He is also a Canada Research Chair in chronic disease, prevention, and management.
Meet the CARE coordinator
Kari Meneen is a registered nurse and certified diabetes educator. She has worked in Big Stone as a home care manager, as a home care nurse in various northern communities, and has spent time working on a mobile diabetes screening initiative with Dr. Ellen Toth, as both a lab technician and as a nurse.