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Case Reports
. 2020 Apr:162:108066.
doi: 10.1016/j.diabres.2020.108066. Epub 2020 Feb 8.

Closing the indigenous health gap in Canada: Results from the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) program

Mariam Naqshbandi Hayward  1 , Romina Pace  2 , Harsh Zaran  3 , Roland Dyck  4 , Anthony J Hanley  5 , Michael E Green  6 , Onil Bhattacharyya  7 , Merrick Zwarenstein  3 , Joelle Emond  8 , Cynthia Benoit  9 , Marie L Jebb  10 , Stewart B Harris  3 ; FORGE AHEAD Program Team
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Free article
Case Reports

Closing the indigenous health gap in Canada: Results from the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) program

Mariam Naqshbandi Hayward et al. Diabetes Res Clin Pract. 2020 Apr.
Free article

Abstract

Aims: TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD) partnered with local clinical and community teams in 11 First Nations (FN) communities across Canada to develop quality improvement (QI) initiatives aimed at improving T2DM.

Methods: Pre-post mixed-methods case study design was used. The 18-month intervention included community and clinical readiness, development of a community diabetes registry and clinical system, and QI activities. Participants consisted of community members, 18 yrs and older, with diabetes. Changes in clinical outcomes and clinical practice guideline (CPG) recommendations were assessed pre and post intervention using multilevel regression (patients nested within communities) adjusted forindividual andcommunity baseline characteristics.

Results: No significant change in HbA1c orsBP, but a small reduction indBP(-0.75 mmHg, p < 0.05) and LDL (-0.09 mmol/L, p < 0.05) was observed in 2008 adults with T2DM (mean age: 60·5 (SD:14·6) years; female: 57·2%). Individuals not at CPG targets at baseline had significant reductions in: %HbA1c (N = 616): -0.40 (95%CI:-0·55,-0·24),sBP (N = 561): -7·67 mmHg (95%CI:-9·23, -5·72),dBP (N = 291): -7·46 mmHg (95%CI:-8·69, -6·26), LDL (N = 450): -0·37mmo/l (95%CI:-0·44, -0·29).Annual HbA1c (OR: 1·95; 95%CI:1·66, 2·29), BP (OR: 1·78; 95%CI:1·52, 2·09), LDL (OR: 1·27; 95%CI:1·10, 1·47) and CKD screening (OR: 6·37; 95%CI:5·16, 7·92)increased but retinopathy screening decreased (OR: 0·68; 95%CI:0·57, 0·82). No significant change in foot exams (OR: 0·97; 95%CI:0·76, 1·23) or BMI recordings (OR: 0·96; 95%CI:0·82, 1·12) was seen. Overall, individualsweremorelikely to receive ≥75% of CPG recommended services compared to baseline (OR: 1·51; 95%CI:1·27, 1·80).

Conclusions: FORGE AHEAD is the first Canadian study to demonstrate that a FN community-led QI intervention can lead to diabetes improvements.

Keywords: Chronic disease; Community-driven; Diabetes; First nations; Indigenous peoples; Quality improvement (QI).

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Conflict of interest statement

Declaration of Competing Interest MNH, HZ, and SH were funded from the grant supporting this study. All remaining authors declare that they have no competing interests.

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