Health Transition Fund Project NA012: Diabetes Community/Home Support Services for First Nations and Inuit

Executive Summary

The increasing prevalence of diabetes has become a major health concern for Aboriginal people over the past decades. This increase has been accompanied by an escalating need for home and community care services and support for persons and families who are affected by diabetes.

The Diabetes Community/Home Support Services for First Nations and Inuit Pilot Project was carried out under the direction of the First Nations and Inuit Health Branch of Health Canada, and was overseen by a Project Steering Committee comprised of federal, provincial and First Nations and Inuit representatives. The Project was initiated in the Spring of 1999 and the evaluation took place in the Fall of 2000.

The expected outcomes from the Project, described in the Report, were:

• the development of sample service models;
• the identification of diabetes education and training, care and support needs for First Nations and Inuit communities;
• the validation of the First Nations and Inuit Home Care Framework and elements of the Aboriginal Diabetes Initiative; and
• the subsequent communication of this information to other communities planning diabetes services/home and community care services.

Major Findings of the Project

The analysis of the data gathered from the Project pointed to some common findings that may have relevance to other First Nations and Inuit communities who are planning diabetes community/home support services.

Identified Diabetes Service Needs

The needs assessments in each community had clearly identified gaps in three areas: diabetes education services; improved coordination of services; and care and treatment. The planning and development of services in each of the pilot sites focussed generally on these areas.

"The big picture is already showing us what is happening with in our people with diabetes. Sharing and learning through projects such as this one has given us a better understanding of diabetes." Health Director - Red Earth First Nation

Models of Home Care Diabetes Services

The four participating communities developed three unique models of home care diabetes services:

• contracted diabetes education service with community coordination, liaison and support;
• multi-disciplinary team approach with health and social support staff; and
• home care nurses with diabetes expertise in case management, diabetes education and care.

All of the models showed preliminary positive impacts for people with diabetes and for the community. The success of the services was not determined by the service model itself, but rather by how well the model fit with the needs of the community, the degree to which it had the support of the leadership and the dedication of appropriate human resources to the services.

Health Staff Diabetes Training and Education

Key health staff in each of the pilot communities identified the need for more diabetes education and training during the needs assessment. The learning acquired during the course of the Project was considered essential for the development of the diabetes services by professional and paraprofessional staff. Before the clients could receive education, the health staff needed to learn about diabetes and become confident in their ability to provide care and treatment.

"All staff involved need training in the care of diabetes. The home support workers have identified urgent care needs for their clients."
Rigolet Nurse

Once the nurses had accessed training and education, they were not only able to provide education and care for persons with diabetes and their families, but they also were able to provide education for the other health care staff.

Some of the nursing staff reported that they had made changes in the way they provided information as they had become more sensitive and skilled in client centred education and care. Others commented that they had an increased awareness of how difficult it is for their clients to make the eating and other lifestyle changes required for diabetes control.

Integration and Coordination

The pilot communities demonstrated that many of the identified service barriers can be fully or partially overcome through integration and coordination of services. To achieve this required first the allocation of human resources and focussed efforts to identify the barriers. The next step was the establishment of linkages and the utilization of a team approach. Communication processes were then formalized to ensure the team members were working with more complete and current client information such as client records and lab reports. Team work amongst all health service staff both within and outside the community was found to be crucial. Physicians, who were part of the team, found that their clients benefited from this approach.

Validation of the First Nations and Inuit Home Care Framework

The four pilot communities found that the First Nations and Inuit Home and Community Care Program clearly provided an infrastructure that supported the delivery of diabetes services for education, care and support. The elements of the Home and Community Care Program facilitated the improvement of care for persons with diabetes, especially in the areas of case management, linkages with other services and the establishment of home care nursing.

"The pilot project was good for our community - It has been a big turn around. People didn't used to talk about diabetes, now people are sharing ideas and asking for help from the health staff. Even elders are talking about the old days. We have workers we can trust to talk to and share ideas with."
Health Director - Red Earth First Nation

Validation of the Aboriginal Diabetes Strategy

The Aboriginal Diabetes Strategy Framework Document (Draft January 1999) was provided to the pilot communities to assist with their planning and development activities. The diabetes services, developed through the Project, are described in the context of the elements of the First Nations and Inuit Communities Program Framework of the Aboriginal Diabetes Initiative (ADI). These elements are care and treatment, prevention and promotion, and lifestyle supports. While the focus of the Project was care and treatment, preliminary effective impacts were shown through the Project in each of the elements identified in the ADI Framework. The diabetes home care services developed through the Project validated the Aboriginal Diabetes Strategy and the elements described in the ADI Framework.

Conclusion

The Project participants, including representatives from leadership, clients and staff were able to identify improvements in diabetes services through this Project. There was an increase in community awareness of diabetes, an increased skill and knowledge of health staff, and some clients had identified changes that they made in their self care and lifestyle to improve their diabetes management.