Community-driven project improves patient outcomes for diabetes in Indigenous communities

A Western based project has led to significant improvements in health outcomes for people living with diabetes in Indigenous communities across Canada. The FORGE AHEAD project was launched in response to data showing the incidence and prevalence of type 2 diabetes was significantly higher among Indigenous populations and that people living in Indigenous communities were less likely to receive adequate care.

The project, which officially wraps up on March 31, 2020, used Quality Improvement (QI) methods and the integrated population health principles of the Expanded Chronic Care Model to drive forward unique initiatives for diabetes prevention and clinical management. Recognizing that the model of care varies by province, isolation level and community size, the main thrust of the project was to empower community leaders and health care providers on Indigenous reserves to take a leading role in the design and implementation of health care initiatives in their unique contexts.

“The community members are the experts at knowing what will work within their contexts,” said Dr. Stewart Harris, Professor at Western’s Department of Family Medicine, Schulich School of Medicine & Dentistry and the FORGE AHEAD program’s Principal Investigator.

“There has been an unfortunate history of research involving Indigenous communities where research has been done to communities rather than with communities. We believe that we have made great strides in working with Indigenous communities in this important research partnership.”

The FORGE AHEAD team, based at Schulich Medicine & Dentistry, provided the quality improvement framework, which included readiness consultations, ongoing coaching and support, an online diabetes registry and clinical tracking system, and a series of three QI training workshops where communities could seek support from the FORGE AHEAD team and share ideas and best practices with other communities in order to move their unique initiatives forward.

In total, nine Indigenous communities from coast to coast completed the program, each with their own set of goals and interventions. At the program level, the researchers saw significant improvements in important clinical indicators for diabetes, including blood glucose control, blood pressure and LDL cholesterol for high risk patients.

They also saw an increase in the number of patients who participated in important diabetes management services including a six-fold improvement in screening for kidney disease. After the introduction of FORGE AHEAD, patients with type 2 diabetes were 51 per cent more likely to have had at least three quarters of the recommended services for diabetes care as outlined by the Clinical Practice Guidelines from Diabetes Canada.

“This project was about finding innovative ways for each community to address their priorities,” said Harsh Zaran, Program Coordinator for FORGE AHEAD. “It was about creating the space for each community to leverage the strengths they already have. We helped to keep the momentum going by providing support and guidance through the process.”

Cynthia Benoit is a social worker from Miawpukek First Nation, the only reserve on the island portion of Newfoundland Labrador. In that community, the team used the FORGE AHEAD model to implement a Lunch and Learn sports program for youth to improve physical activity, a data collection system to monitor diabetes patients in the community and also developed a series of initiatives with pregnant woman to increase awareness and knowledge around gestational diabetes management from pre-natal to post-natal.

“There is no cookie cutter approach that works for all communities. FORGE AHEAD empowered the community to develop a plan to increase health outcomes for persons with diabetes and were instrumental in making sure our plan was reflective in supporting what was best for the communities and the health centres,” said Benoit. “The FORGE AHEAD team did not dictate what we should do as a community, instead, they supported us to work on our priorities from a community perspective and they supported the clinical and community teams to develop action plans based on the activities that we felt would be beneficial to community members and that were relevant to the community.”

The team will now build upon the success of FORGE AHEAD to create a toolkit that can be scaled up further across the country with Indigenous partners. The new QI program, called REACH, will launch in early 2020.