Diabetes Education Program serving people in Ontario’s far north

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The Weeneebayko Diabetes Education Program, offered through Weeneebayko Area Health Authority (WAHA), is a community based program that assists adults with Type 1 and Type 2 diabetes and pediatrics with Type 2 diabetes, at any stage of the disease. Our program’s focus is on providing education that assists with the treatment and self-management of diabetes and the prevention of diabetes complications. People living with diabetes should see their diabetes education team at least every 6 months if well controlled or every 2-4 weeks if not well controlled.

Our program provides service to residents within the Town of Moosonee as well as Moose Factory (Moose Cree First Nation and MoCreebec Council of the Cree Nation), Fort Albany, Kashechewan, Attawapiskat and Peawanuck First Nations – these communities are located in the James and Hudson Bay Region of Ontario. The Diabetes team consists of 6 staff members; 2 Registered Nurses, Jordana Johnstone and Sandy Sutherland, 2 Registered Dietitians, Melissa Hardy and Alana Barry, 1 Registered Practical Nurse who specializes in foot care, Patricia Chum, and 1 Administrative Assistant, Barb Hardisty. This past year, the diabetes team of Nurses/Dietitians saw 1314 clients in total, which was close to double the amount of clients seen in 2014-2015. Our Foot Care nurse saw 679 clients, which was a four-fold increase from 2014-2015!

Service Locations

The Weeneebayko Diabetes Education Program is located on the second floor of  Weeneebayko General Hospital in Moose Factory. We provide one on one and/or group appointments with the Nurse, Dietitian and/or Foot Care Nurse. Our program is funded for 1 coastal diabetes clinic per month. Our team travels to Fort Albany, Kashechewan or Attawapiskat, once per month, which means each coastal community is visited almost every 3 months. We also travel to Peawanuck twice per year and hold clinics in Moosonee roughly 3-6 days per month. In the past year, we have travelled to Fort Albany and Attawapiskat 3 times and Kashechewan and Peawanuck twice.

Challenges

Our program faces many challenges but we are working diligently to overcome these.  In particular, we have a limited number of staff to meet the demands of the growing population with Diabetes, especially in our coastal communities. Our coastal clinics are often cancelled for reasons beyond our control (i.e, weather, housing/accommodations, clinic space, travel). Our programs standing orders for diabetes are difficult to meet, our orders are to see a patient every 2-4 weeks if they are not well controlled, and then every 6 to 12 months if well controlled. 58% of people with diabetes in our communities are poorly controlled (defined as having an HbA1c over 7.5%), thus significantly increasing the risk of developing diabetes complications. Out of the 58%, 26% are very poorly controlled (defined as having an HbA1c over 9.5%). We realize that we do not have the staffing to be in all communities as often as we would like, so we have partnered with the Ontario Telemedicine Network (OTN).

Outreach Strategies

We have been using OTN on a regular basis to schedule appointments with the coastal communities. In the past year we held 6 OTN clinics with Attawapiskat, 4 with Kashechewan, 3 with Fort Albany and 2 with Peawanuck.  New this May and June, our program has developed a quarterly diabetes newsletter to promote and encourage people to contact the Program, for booking of telephone, OTN or in person appointments. It will also provide diabetes education information and showcase people’s journey with diabetes and share how they gained control of their disease. The newsletter will be distributed via direct-mail campaign to all of the residents in our communities.

Diabetes has a negative connotation in our communities and we hope to break the stigma, reassuring people that diabetes is manageable and that many treatment options are available to prevent or delay diabetes complications.

Improvements in Program Participation

As a result of the various options available connecting people to our program, participation in OTN and telephone appointments has significantly increased. From 2014-15 to 2015-16 our OTN appointments increased by 78% and our telephone calls have increased by 339%! We recognize that this is a fantastic improvement and we will also work to increase the number of in-person visits. We are continuing to work with our coastal clients and community-based health care providers to remind clients that they can access our program even when we are off-site. Rates of diabetes in aboriginal peoples are much higher than the rates of non-aboriginal peoples and prevalence of diabetes is even higher for the aboriginal population living on reserve versus off reserve. Please make sure you recognize your patients’ risk for developing type 2 diabetes and make sure to screen the patient if they have one to two risk factors. Many people live with undiagnosed diabetes for years and this increases their chances of already having more than 1 diabetes complication at initial diagnosis.

Remember to be active and support one another!