Billings Area Model Diabetes Program

Blackfeet Diabetes Program
Browning, Montana

Debbie Powell-Taylor, R N, B S N, Coordinator
Blackfeet Community Hospital
P. O. Box 760
Browning, Montana 59417
Phone: (406) 338-6305
FAX: (406) 338-6195
E-mail: Debra.Powell-Taylor@ihs.gov

Program Description

Began in 1987 under the Blackfeet Indian Health Service (I H S) Service Unit. Serves the reservation and outlying areas, urban centers in Great Falls, Helena, Butte & Missoula and Billings Area, I H S. Program mission is to provide education on the prevention of diabetes to the Blackfeet people, and assist those persons with diabetes to improve their quality of life as they work at controlling their diabetes.

Data/Epidemiology

• In Fiscal Year (F Y) 1999 the service population for the Blackfeet Service Unit was 8,825. People with diabetes 11% of total population, 20% of those over 20 years, & 49% of those over 50 years.
• Number of people with diabetes who receive diabetes care is 830
• In F Y 1988--331 identified people with diabetes, in F Y 2000--1,050 people with diabetes
• In F Y 1997, diabetes was the second leading cause of outpatient visits
• Registries in place: general diabetes, impaired glucose tolerance, complications--gestational diabetes, amputations, end stage renal disease (hemodialysis, peritoneal dialysis, transplants, and pre-renal patients).

Clinical Accomplishments

• Primary clinical function: patient advocacy for standards of diabetes care
• Coordination of Blackfeet Service Unit's diabetes clinic activities
• Use of diabetes chart section, color-coding charts, clinic flow sheet, and creation of preprinted P C C Patient
• Encounter forms for clinic, screening, chart reviews and education.
• Diabetes Tracker Project from Billings Area Office: computerized method/tool to share patient data & batch process reports, allows local providers ability to analyze reports and show trends for standards of diabetes care and educational efforts. Physician report card and patient report card forms are available. Program can link services in
• I H S, tribal and urban programs.
• Coordination of home blood sugar monitoring program.

Education Programs

• Diabetes education programs--individual counseling, group counseling or family education for diabetes, nutrition and fitness
• Self Care workshop--held 5-6 times per year, targeting newly diagnosed patients & family
• Strong Women Stay Slim--12 weekly sessions for women: nutrition tips, strength training, and aerobics. Program evaluation shows women are increasing muscle mass & decreasing body fat
• Transtheorical model of behavior change--In coordination with the Blackfeet behavioral department, to change the approach of health care workers in assessing the readiness to change and use of appropriate educational methods and tools to help people with diabetes make lifestyle changes.

Community

• "Celebration of Life"--a nutrition education activity to honor the challenges that community people face when living with diabetes.
• Annual adolescent health screens for middle and high school students
• Professional education provided to nursing and public health nutrition students
• Community diabetes screening in coordination with Tribal diabetes project & C H R's
• Diabetes education workshops and presentations (as requested) including nutrition, fitness, general diabetes care and education. Presented to community members, tribal officials health care professionals and paraprofessionals
• " Cooking for Good Health" class--once a month at local school
• SHOP SMART Grocery Store Tour--A supermarket tour program for community members
• Education for the Billings Area Intertribal Diabetes camps beginning in 1989.

Resource Development

• "Cooking for Good Health" manual--lesson plans, handouts and recipes for 5 cooking classes
• " Low fat cooking" video-30 minutes--produced with Fort Peck Diabetes Program
• Gestational diabetes nutrition "Pin"--award winning tool helps women with diabetes in pregnancy learn exchange diet system
• " Exercise interventions in the Gila River Indian Community" which is now the diabetes prevention study
• Strong Women Stay Slim manual--preprinted P C C s, handouts, and activity lessons
• Preprinted patient encounter forms for diabetes clinic, diabetes screening, monitoring supplies, self-care education, nutrition education, fitness assessment and education, diabetes education
• Diabetes clinic flow sheets and education flow sheets

Unique Contribution

• Assistance to Billings Area Diabetes Consultant to provide technical support to area clinics
• Assistance to Montana Diabetes Control program and Alberta First Nations Diabetes Task Force
• Registered Dietitian is recognized nutrition authority within the Blackfeet community & in the nutrition & dietetics field.

Challenges

• The diabetes population was 331 in 1988; it is now 1,050 in F Y 2000. The number of staff has been reduced from six to four
• The biggest challenge in the next two years will be the major reconstruction in the Blackfeet outpatient departments. The program has moved seven times since 1988; the next move will be to a permanent and central location within outpatient services.