Phoenix Area Diabetes Model Programs

Journey Into Wellness Center
Gila River Diabetes Education Center
PIMC Diabetes Center of Excellence (P I M C)


Journey Into Wellness Center
Ft. Duchesne, Utah

Jim Whiting, R N, D O N, Acting Director
Uintah & Ouray Service Unit
PO Box 160
Ft. Duchesne, Utah 84026
Phone:(435) 722-5122
FAX: (435) 722-4122
E-mail: Jim.Whiting@ihs.gov

Program Description

This Uintah & Ouray I H S Service Unit diabetes prevention and control program is located in Fort Duchesne, serving Native Americans of Utah (approximately 4000 population base). Program staff includes Program Director/dietitian, nurse educator, fitness educator and secretary. The special diabetes grant has supplemented the program with an outreach worker and gym operator.

Data/Epidemiology

• 360 patients on registry
• Other registries--gestational diabetes, amputations, staged diabetes management, & dialysis.
  

Clinical

• Coordinates weekly diabetes clinic ensuring timely appointments, treatment and follow-up
• Comprehensive diet, exercise, and life-style education provided. Follow-ups at office or home visits
• Self monitoring blood glucose monitor training and supplies provided
• Routine foot checks, wound management and other complications patient education
• Staged diabetes management implemented 1996-1998.

Education

• Professional in-service training for clinic staff
• Paraprofessional training for CHR's and other community program and school staff
• Videos on diabetes complications and care produced and shown in clinic
• Lifesteps, Holiday Eating Learning Program and other weight control education
• On-going community health promotion, disease prevention workshops.

Community

• Established obesity prevalence in local school children--implementation of SPARK Physical Education program in 5 local K-6 schools
• On-going health education provided at local school classrooms, senior center and other community locations
• Eight annual summer youth food, fun and fitness programs--an interagency cooperative effort to improve health in up to 70 children per summer.
• Two annual winter youth programs with ice skating and cross-country skiing
• Certified local aerobics instructors who now conduct routine classes throughout the reservation
• Fitness program and gym
• Worksite wellness program coordinated by program
• Annual fitness events such as 100 mile club and family Olympics
• " Wellness Checked" supermarket nutrition education campaign. Low fat and sugar items are identified with a wellness check on the shelves at the Ute Market.

Resource and Product Development

• Summer youth health promotion video
• Various fitness and eating education brochures
• Home blood sugar monitoring log.

Growth and Challenge

• Administration of the Tribe's special diabetes grant and associated activities with the addition of 1.5 full time equivalent
• Needing additional space for gym, fitness and nutrition classes and other health promotions such as stress reduction, yoga, as well as meetings.

Unique Contributions

• Implementation of physical education program with local school network
• Nutrition education campaigns and materials in the schools, supermarket, newspaper, and other community locations.
  
  
  

Gila River Diabetes Education Center
Sacaton, Arizona

Melanie Swisher, Coordinator
E-mail: melanieS@grhc.org

Director, Diabetes Education Center
HuHUKam Memorial Hospital
P.O. Box 38
Sacaton, Arizona 85247
520-562-3321 Ext. 1548
Toll Free 1-888-HuHuKam
Fax: 602-528-1472


Training

• Use audit data to annually conduct performance improvement, including educating staff on diabetes standards of care
• Annual peer review of charts in the Diabetes Education Center
• Provide education to staff and casino employees through classes and inservices
• Annual community diabetes conference.

Standards and Diabetes Audits

• Use IHS Diabetes Standards of Care with annual audit
• Adhere to National Diabetes Education Standards for diabetes education to maintain American Diabetes Association (ADA) Recognition
• Prenatal care protocol
• Documentation audit for diabetes education center staff.

Primary

• Wellness/Fitness Center open to Community and Staff
• Participate in community health fairs
• Collaborate with Public Health on prevention/high-risk for Type 2 patients

Secondary

• ADA recognized education program since 1995
• Developed and implemented the use of an annual flow sheet for the chart
• Ongoing development of patient education materials specific for the community
• Diabetes Coordinating Committee meets bimonthly to facilitate needs of individuals with diabetes and continously evaluate and improve care processes within the hospital home blood sugar meter program
• Foot screening
• Flu shots.
  

Tertiary

• Active referral process to onsite podiatry, dental and optometry clinics
• Inpatient rounds and education provided to patients admitted for a reason directly related to diabetes or found to have educational needs while on the inpatient unit.
• Implementing a community high-risk diabetes case management program
• Collaborate with Public Health to manage high-risk gestational diabetes patients and high-risk Type 2 community members

Conference Presentations

• Diabetes Education to community groups, businesses, casinos
• Community Cooking Classes and Nutrition Classes at Service Centers, Clinics, Community Centers/ Diabetes Education Center

Challenges

• Need more community outreach in programming
• Accurate data collection and reporting based on epidemiological data for case management and chart audits
• Complete the implementation of the case management program and behavioral health interventions program
• Identifying program format to better meet the needs of the community
• Requesting consideration for a Medical Staff Diabetes Yearly Clinic Program and an Intensive Diabetes Specialty Care Clinic Model program
  

Outcomes

• Improved HbA1c levels from 1998 data
• Improvement in numbers counseled on tobacco use
• Greater diversity in drug treatment regimens used by providers
• Increased use of ACE inhibitors
• Increase in flu shots given
• Increase in urine screening
• Increase in microalbuninuria screening
• Increased creatinine levels being tested
• Increase in cholesterol and blood fats (LDL) screening
• Large increase in the number of people doing home blood sugar monitoring
  

Resources/Products

• Pamphlets and handouts on all areas of diabetes education, i..e., cost comparison of health foods vs. "junk" food, label reading, exercise, medications, sick days, etc.
• Preprinted PCC on home blood sugar monitoring, insulin injection, annual nutrition, Pre-conception counseling, behavior change goals (initial & follow-up), prenatal nutrition
• Video: "Community Perspectives on Diabetes Education", 1998
• Diabetes Camp for Kids with Type 2 Diabetes or at high risk, in collaboration with the GRIC Public Health Department and the Center for Native American Research at U. of Arizona.
  

Unique Contribution

• Maintains American Diabetes Education Program Recognition
• Technical Assistance to other I/T/U's Phoenix Area: Sells, Salt River, Santa Rosa, Keams Canyon, San Lucy, Navajo, White River Apache, and Native American Research and Training Center.
  

P I M C Diabetes Center of Excellence
Phoenix, Arizona

Charlton Wilson, M D
Phoenix Indian Medical Center
4212 North 16th Street
Phoenix, AZ 85016
Phone: (602) 263-1587
Fax: (602) 263-1624
Email: Charlton.Wilson@ihs.gov