D.I.P.

Diabetes Integration Project (D.I.P.)

The Diabetes Health Care Integrated Service Delivery Model, aka “Diabetes Integration Project” resulted from:

AMC Resolution JAN-05.02 Establishment of Manitoba First Nations Diabetes Prevention Centres of Excellence which supported the establishment of a northern & southern Centre of Excellence.
AMC Resolution JUN-05.01Manitoba First Nations Plan of Action on Diabetes which supported the integration of the Diabetes Center of Excellence with the Diabetes Outreach Care & Treatment Model.
AMC Resolution AUG-06.01 Manitoba First Nations Integrated Diabetes Health Care Service Delivery Model which approved in-principle the Integrated Diabetes Health Care Service Delivery Model as a framework for action.

The Manitoba First Nations Diabetes Strategy – A Call to Action

In 1999 the Manitoba First Nation Diabetes Committee in response to the diabetes epidemic declared by First Nations in 1997 developed the Diabetes Strategy “A Call to Action.”

The Diabetes Strategy – A Call to Action identified 5 priority areas to be covered to address the diabetes epidemic in First Nations:

Care and Support
Prevention and Promotion
Gestational Diabetes
Research, Surveillance, and Evaluation
Policy and Infrastructure

The Manitoba First Nations Diabetes Committee (MFNDC)

The Manitoba First Nations Diabetes Committee was formed in early 1999 and was given the mandate to develop a Manitoba First Nations Diabetes Strategy
5 priority areas were identified to deal with the diabetes epidemic
The Aboriginal Diabetes Initiative was introduced in 1999. The work of the MFNDC is based on The Manitoba First Nations Diabetes Strategy A Call to Action. In the first 5 years of ADI, the focus was on section 1, prevention and promotion. Community ADI workers were hired and the majority of their work focused on prevention/promotion of diabetes
2004/09 – the focus of the MFNDC is on section 2 of the MB First Nations Diabetes Strategy – Care and Support

Diabetes Integration Project – Purpose

The Integrated Diabetes Health Care Service Delivery is a mobile diabetes care and treatment services model which will begin to address the needs of First Nations people already diagnosed with diabetes by providing them with direct services to help monitor their diabetes status, screen for and prevent further complications from developing, and provide diabetes education to clients to encourage self-management.
The Mobile Program Model was developed to overcome barriers to access to a comprehensive, coordinated and integrated care and treatment services for limb, eye, cardiovascular and kidney complications.
As part of the model, the CDA Clinical Practice Guidelines will be implemented as a standard of care utilizing evidenced based diabetes practice with respect to screening, education, care and treatment.
The full implementation will consist of 11 mobile diabetes health care service delivery teams. Each team consists of two nurses. The teams were to be located in 5 geographical regions for the provision of diabetes care and treatment services within the First Nations communities.

3 Teams in Thompson
1 Team in Dauphin
1 Team in The Pas
1 Team in Brandon
5 Teams in Winnipeg (1 team would be assigned exclusively to the Island Lake region)

Each mobile Diabetes Health Care Service Delivery Team will serve a population of 8000 First Nations people.

Diabetes Care and Treatment Service Delivery

Implementation of the diabetes care and treatment plan to include the following:

Complication and Risk Factor Assessment
Diabetes foot care (limb)
Retinal screening (eye)
Cardiovascular (heart) – Point of Care Testing (DCA 2000 and Cholestech LDX Analyzer)
Renal function (kidney)
Mental health (depression screening)
Coordinating specialist consultations
Diabetes education services
Nutrition and physical activity counselling
Capacity building of clients and the local health care teams
The Canadian Diabetes Association Clinical Practice Guidelines is the standard of care to be provided to every diabetes client within Manitoba, including First Nations. The MFNDC focus will be to ensure that diabetes care and treatment standards of care are being met

Support to the Mobile Teams

Support to the Mobile Diabetes Health Care Service Delivery Teams will include the following:

4 dietitians (2 community outreach, 2 clinical)
2 retinal photography technicians
Mental Health provider (contract as needed)
Program Medical Advisor
Physician specialists (contract as needed)
Surveillance Coordinator/Database programmer
Administration support (visit scheduling, financial tracking)

Diabetes Integration Project – Core Team

To develop the Diabetes Integrated Service Delivery Model a core team is required, consisting of: Current Positions:

Executive Director – Caroline Chartrand
North Coordinator – Karen Beardy
South Coordinator – Frances Desjarlais
Province Wide Coordinator – Kathryn Aubin
Dietitian – Robin Miller
Admin Support – Sally Harper

Recruitment is currently underway for a Surveillance Coordinator who will assist in the information technology and information management area.

Diabetes Integration Project – Contracts

Medical Program Consultant (Dr. Barry Lavallee) to the Diabetes Integration Project.
Quality Assurance Contract – (Dr. Lyle Redman, Clinical Biochemist) to ensure the Point of Care Testing equipment is accurate and precise.
Mental Health Contract (Dr. Alex Wilson) who will conduct an environmental scan and recommend the integration of traditional healing services and mental health screening within the mobile diabetes care and treatment services being delivered.
Comprehensive Foot Care Contract (Melanie MacKinnon) – to assess the foot care services currently available, the First Nation and Inuit Health NIHB policies, review of the referral process and the Standards of Practice, and to provide recommendations on the provision of foot care services.

Community Selection Process

The Manitoba First Nations Diabetes Committee utilized specific criteria for communities to be included as pilot sites for the first year. The criteria included the following:

high needs of the community
size of the community – small, medium, and large to represent variety of sizes
existing services, traditional/cultural component
Pat Marten’s study – The Health and Health Care Use of Registered First Nations in Manitoba – A Population Based Study (2002) which would show the communities in greater need

First Nation Communities – North Pilot Sites

Chemawawin
Oxford House (Bunibonibee)
Nelson House (Nisichawayasihk)
Split Lake (Tataskweyak)
God’s River (Manto Sipi)
God’s Lake Narrows

First Nation Communities – South Pilot Sites

Hollow Water
Peguis
Long Plains
Dakota Tipi
Dakota Plains
Swan Lake

Should you have any questions, please do not hesitate to contact the Diabetes Integration Project office at 956-7174.

Respectfully prepared by:

Caroline Chartrand
Executive Director
Diabetes Integration Project