As Canada continues its fight against diabetes, a group of scientists and health-care professionals are focusing their efforts on communities that bear a greater burden of this disease than the rest of the country: First Nations, Inuit and Métis communities.
Through a five-year program called FORGE AHEAD – short for TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery – these scientists and health-care workers are working with Aboriginal groups across the country to identify local health challenges and improve the delivery of health care through better coordination of clinical and community services.
“The gaps in health care in Aboriginal communities are much greater than what we see in the general population,” says Dr. Stewart Harris, the program leader and a professor at Western University’s Schulich School of Medicine and Dentistry. “At the same time, they face greater health challenges.”
Compared to the general population, the rate of diabetes is between two to three times higher in First Nations communities and one-and-a-half times higher among Métis, according to Statistics Canada.
In Inuit communities, where type 2 diabetes used to be rare, the disease now affects residents at rates that are comparable to those among non-Aboriginal groups.
Dr. Harris hopes that by changing the current models of healthcare delivery in Aboriginal communities, the upward trend of type 2 diabetes can be halted and reversed. He notes that most First Nations communities have a federally funded diabetes prevention program as well as health-care clinics. But what’s often lacking is co-ordination between the two.
“One of our goals is to facilitate the integration of community and clinical programs to create, in essence, a cohesive healthcare team,” he says. “So if I’m a doctor in a clinic seeing a patient who has diabetes, I could easily set up my patient with a walking program in the community or send him to a particular person for diabetes education. And we would all communicate with each other and co-ordinate what we’re doing for this particular patient.”
This would lead to better outcomes for patients, says Dr. Harris, and help Aboriginal communities optimize limited resources. So far, he says, 12 communities from various provinces have expressed interest in FORGE AHEAD, which is funded by a $2.5-million grant from the Canadian Institutes of Health Research and a $500,000 donation from pharmaceutical firm AstraZeneca Canada. In September, Dr. Harris and his team held their first workshop with representatives from six communities. This was the first of multiple training and quality improvement workshops that will be conducted with representatives from partnering Aboriginal communities over the life of the program.
During five years of FORGE AHEAD, the research team will create a diabetes registry and assess clinical measures to see if the program’s efforts are yielding clinical improvements, says Dr. Harris.
“At the end of five years, we will be developing a tool as part of a knowledge translation strategy to ensure we have a package that other communities can utilize,” he says. “If we get it right with diabetes, then the lessons learned can be expanded across the whole chronic disease profile.”