TUCSON, Ariz. – Turning good health practices into reality and getting patients with cardiovascular disease and diabetes to participate in programs designed to help them is often difficult for caregivers. Halting the progression of these diseases often hinges on how successfully research findings can be made to work in community-based settings.
Seeing this as a challenge, in 2004 Congress directed IHS to launch the Special Diabetes Program for Indians Demonstration Projects. These 5-year grant funded projects were designed to help tribes focus on preventing diabetes and reducing cardiovascular disease risk in American Indians who have diabetes.
Since then, IHS has set aside $27.4 million a year for the SDPI through fiscal year 2008. Diabetes Prevention Demonstration Projects were awarded to 36 tribal and urban Indian health programs and Healthy Heart Demonstration Projects were awarded to 30 programs. Due to the program’s successful outcomes, SDPI has been reauthorized through 2011.
The grant programs, according to co-director of the Coordinating Center for the SDPI Demonstration Projects, Yvette Roubideaux, MD, MPH, use a clinical, team-based case management approach to treat risk factors for cardiovascular disease. Both demonstration programs have another year left under the grant before the final evaluation is completed. “We are very hopeful that the final analysis of the program will see that these activities have been effective,” Roubideaux said.
Another component of the SDPI projects are the Community Directed Grant Programs which received varying amounts of funding depending on the burden of diabetes in those communities and the number of people served by the programs. These programs promote the development of local programs based on local needs and priorities. “There has been a significant increase in access to services for diabetes prevention and treatment in these programs. In terms of outcome there has been a significant reduction in the average level of blood glucose control in Indian communities of over one percent. Research shows that if you can reduce hemoglobin A1c levels by one percent you can reduce the complications of diabetes by 40 percent,” she said.
She said $150 million a year in IHS dollars funds about 333 Community Directed Programs in addition to the 36 diabetes prevention and 30 healthy heart programs. “The rate of heart disease in American Indians has grown rapidly as American Indians are living longer, the rates of diabetes and obesity has also gone up. Cardiovascular disease is about two times greater in American Indians compared to similar populations in the U.S. While the rest of the country’s mortality from heart disease is going down, for American Indians it’s still going up.
“That is why the Healthy Heart Project is so important; the intensive case management allows individuals with diabetes to come to the clinic once a month and meet with the case manager and go over what their risk factors for heart disease are. There is a big focus on reducing those risk factors to get blood pressure under control, getting people to stop smoking, control high blood cholesterol, reduce blood glucose, weight management, life style changes and reduction in stress levels,” she said.
“The Yakama Indian Health Center in Toppenish, Wash. and Dr. Rex Quaempts, Healthy Heart Project director, are doing a really innovative thing there – they are involving pharmacists in their case management team.”
“Pharmacists today are trained to be more clinically oriented, rather than just dispensing medications they are more intimately involved in direct patient care,” Quaempts said. “In our situation we have carved out clinic time and each pharmacist is assigned anywhere from 25 to 50 diabetic patients registered in the Healthy Heart Program to take care of. They are responsible to see them on monthly visits at the time they dispense medications and can change their medications, order labs and do simple foot exams as well as making sure their patient’s annual exams are current.
“The pharmacy guarantees me a 35-hour week diabetic clinic with eight pharmacists who rotate either a half or full day to staff the clinic. Currently we have over 1,000 patients who utilize the clinic. Registered in the Healthy Heart Program there are about 250 diabetic patients.
“When I wrote the grant I wrote it based on using the pharmacists as case managers. In my opinion my pharmacists probably do a better job at medical management of diabetes now than the physicians. They see their patients more often and have a full hour to spend with them for their appointment,” Quaempts said. “We have seen patients LDLs – low density lipids – go down since the inception of the program; 70-plus percent of our patients in the program have levels under 100, which is the goal, compared to 34 percent of patients not in the program. Blood pressure control has seen similar results with 45 percent of those in the program keeping their blood pressure under control compared to only 21 percent of those not in the program.”
The grant also provides for some community projects including a Dance Away Diabetes class, purchasing reservation raised buffalo meat for participants in the program, track meets, a conference on healthy eating and a pow wow.
“I think it is great that the tribes, IHS and the urban Indian health programs were able to step up to the plate and take this funding and create really innovative programs that have made a huge difference in their communities,” said Gordon Quam, RN, IHS consultant and project officer for the 66 grant funded demonstration projects. “I think it is a great example of the potential we have to improve Indian health if we have adequate resources and we have enough information and technical assistance to support programs.”
The IHS Division of Diabetes Treatment and Prevention will be sharing successful outcomes from the final year of the demonstration projects with other American Indian health programs to help tribes start new prevention and risk reduction activities.
Hopefully the successes of the demonstration projects will encourage other tribes to research, fund and implement innovative treatment and prevention programs into real world settings in their own communities.