TUCSON, Ariz. - It's a well-documented fact that among the 73 million Americans classified as diabetic (with one million more diagnosed each year), the disease is most prevalent among American Indian populations. According to National Institutes of Health statistics, of the more than 560 federally recognized tribes, bands, pueblos and villages, ''diabetes is most common among American Indians in southern Arizona.'' And that includes the Pascua Yaqui and Tohono O'odham reservations west of Tucson.
Figures released by the National Diabetes Education Program indicate that 27.6 percent of southern Arizona Indians are known diabetics, with many more still undiagnosed. ''Our patient load has doubled in the last year alone,'' said pharmacists Sandra Leal and Marisa Soto. Leal now deals with more than 900 clients. Soto's patient load is nearing 450. ''And even scarier than the numerical increase is the fact that we're seeing a younger patient population; kids as young as 3-year-olds with Type 2 diabetes,'' Soto said.
''With this early onset, you're going to see complications and a need for dialysis in the early 20s when you don't usually see those problems until the 60 - 80 age group,'' added Leal, clinical pharmacy supervisor at El Rio Community Health Center.
The two women are working long and hard to reverse this trend, and their efforts are being recognized. ''We were one of the top six pharmacy practice sites in the country to be honored last year with a Best Practices award by the American Society of Health Systems,'' Soto said. The accolade recognizes ''excellence, innovation and leadership in health system pharmacy in areas that improve quality of patient care.''
And for this dedicated duo, patient care is what it's all about through the use of old ways in modern times. Since El Rio began treating diabetic patients six years ago (followed three years ago by Pascua Yaqui), success has come from a simple combination of care and compassion mixed with empathy and education that actually makes patients a part of the process.
''We present medical test results, giving patients the facts and numbers and an explanation of what they mean,'' Soto said. ''We start out as coach, outlining a winning game plan. Once patients have the necessary tools, we step back and act as cheerleaders while they run their own game.''
''We're on a first-name basis with our patients and are passionate about what we do and how we do it,'' Leal added. ''We've built up a level of trust with patients who will talk candidly with us. I'm listening to personal issues and family matters, things that may have a bearing on the illness itself. I spend half my day doing social work and the other half doing medication management.''
Leal's treatment clinic opened in the fall of 2001. Two years later, noting the clinic's success, the Pascua Yaqui tribal council awarded a grant to open a similar facility on reservation property where a prevention program was already in existence. Because of the individualized care and concern given and the amount of time taken with individual patients, Tribal Chairman Robert Valencia said, ''This is a unique program that doesn't exist anywhere else in the country.''
With costs of caring for diabetes mellitus patients in the United States approaching $150 billion a year - and the prevalence of diagnosed cases expected to increase by 165 percent over the coming decades - it has become urgent to identify intervention procedures that improve disease control and prevent disease complications. That's where the use of pharmacists as primary care providers for chronic disease patients, a role originally developed by the IHS in the 1970s, is achieving successful results.
''I don't know if they teach empathy in pharmacy school versus a clinical approach in medical school,'' Leal said, ''but I sense patients trust us more because we take the time to explain and educate. I don't just say, 'Take this medication, see you later.' I explain what meds are ordered based on test results and what improvements we expect to see. I don't just tell patients, 'Your A1C count is high.' I outline their numbers and the goal range they should be in and what needs to be done to accomplish that.''
Both practitioners believe their personalized care, time and concern given to each patient is what makes the difference. Still, with the number of patients seeking treatment continuing to rise, Leal, as originator of the personalized patient pilot project, is looking further. ''Our goal is to use the model we've created here to initiate education tools for other community health centers to grow some of the successful intervention methodology we've developed,'' she said.
''We're working with the screening and treatment of people with chronic kidney disease, a related problem for the patients we see as people at the highest risk for CKD are those with diabetes and high blood pressure,'' Soto said. ''We're also trying to collaborate with the National Institutes of Health and their kidney disease program, using our clinic as a pilot site,'' said Leal, who functions as president of the Association of Clinicians for the Underserved. ''This is a huge project we're undertaking, one that will affect a lot of people in a very positive way.''
Still, they've not lost sight of the forest because of the trees. Education has always been a key, to both treatment and prevention. They still educate each patient to a level where they can be their own advocate. ''Prevention is a matter of education,'' said Leal, ''and based on our past success in doing so, we're going to continue our effort to explain this disease and how it can be combated.''