Project: The Alberta First Nations Project to Screen For Limbs, Eyes, Cardiovascular and Kidney Complications of Diabetes Using Mobile Clinics (SLICK)

2005
Canada health infostructure partnerships program (CHIPP)

Synopsis

The impetus for the SLICK Project arose from epidemiological studies, which showed that diabetes and its complications, including circulatory problems in lower limbs, retinal damage in the eyes, and heart and kidney damage, have a major impact on public health costs in First Nations populations. The SLICK Project was proposed as an intervention to reduce the burden of this public health disorder in Alberta First Nations communities. Its purpose was generally to increase awareness of the disease, improve diabetic services, increase early identification of diabetes complications, encourage clients to arrange appropriate follow-up care with long-term outcomes of improving client health, decrease the prevalence of diabetes complications, and reduce the socio-economic cost of diabetes in the First Nations populations of Alberta.

The SLICK Project was a collaborative endeavour between the University of Alberta, Alberta First Nations and Health Canada, and was coordinated by the Implementation Committee of the Aboriginal Diabetes Initiative. To achieve the goals of the project, two vans were set up with the necessary equipment required to conduct a battery of screening tests for complications in limbs, eyes, cardiovascular and kidneys according to the Canadian Diabetes Association (CDA) evidence-based clinical practice guidelines for screening, education and community-based care. These mobile units were deployed into all forty-four Alberta First Nations communities to conduct screening tests for the known diabetic population, to increase population awareness of the complications and the consequences of the complications, and to encourage clients to arrange appropriate follow-up care.

For obtaining retinal images, photographers, trained by a senior technician at the Royal Alexandra Hospital, used a Zeiss 450 Fundus Camera and a Kodak Professional DCS 760 Digital camera to capture high resolution, three-dimensional retinal images. These were captured in the field and delivered electronically to retinal specialists at the Tele-Ophthalmology Unit at the Royal Alex Hospital in Edmonton for interpretation.

Outcomes

The main impact of this study is that high technology health care that might otherwise only be available in larger centres was delivered personally to forty-four First Nation communities throughout the Province of Alberta. Over a thousand individuals were screened for diabetic complications. The SLICK project provided a unique way to address this very serious health problem in Alberta, which may be applicable to other regions or provinces of the Country. Secondly, SLICK offered a means to assess the progress of complications from one period to another, providing care-givers a much improved chance of matching treatment to severity. Thirdly, education of the population about diabetes and its complications was one of the purposes of the project to provide increased understanding for those afflicted or affected and to enable individuals to feel that they personally could have some role in mediating the consequences of this disease.

Some key conclusions include:

• SLICK increased the identification of diabetes complications;
• Diabetes complications decreased: clinical exam findings and lab test results noted improvements over the course of the project including weight reduction, metabolic control, foot risk, and cardiovascular risk factors;
• Visits to physicians increased;
• Visits to emergency rooms decreased significantly, and hospitalizations also decreased.

Human Resources Impact

Improving the knowledge and skills of health care givers and care receivers in the First Nations communities has had a huge impact on the ability of care givers to recognize symptoms of diabetic complications, improve their ability to provide screening for the complications; and on the ability of those with diabetes to recognize that they may be experiencing complications. Furthermore, with increased understanding of the complications and how they may be controlled, care receivers are better abled to take a more active role in addressing factors, which may serve to reduce the severity or rate of progression of complications.

Policy and Research Implications

In addition to the cost minimization analysis done by the quantitative evaluation showing potential cost-effectiveness, only long term follow up and further analysis will reveal the true cost-benefit ratio of a project of this magnitude.

The qualitative evaluation showed true acceptance and satisfaction consistent with the expected preference of having services delivered close to home, with a minimum of personal inconvenience. Whether the intense effort required for this convenience can be justified will require further analysis, probably theoretical modeling. This will have to factor in models of care for chronic disease, where there is inherent inertia in seeking optimal medical care. Resources should be devoted to these further analyses of this costly mode of health service delivery, as suggestions have been made that it be expanded to other areas of the country. The excellent initial database should allow this on-going analysis.

Documents or products generated

Document/Product Name	Available in Paper and/or Electronic Form	Licence Fee Required for use (Yes/No)
User Guide(s) and/or Training Manual(s)	Yes, SLICK Manual	No
Template(s) for equipment testing	QA through contract with CEQAL
Policy and Procedure Manual(s)	Yes (SLICK Manual: both for SLICK and for lab procedures)	No
Job Descriptions and/or recruitment material	Yes, for Van staff
Software Application(s), includes: EHR application Security/access alert software Telehealth scheduling software Other	Yes, SLICK clinical database, and ophthalmology software	Yes for ophthalmology software
Standards, includes: Data (includes minimal data sets) Image Messaging Other	QA standards Safety standards	No
Clinical Program Protocol(s)	SLICK Manual	No
Quality Assurance Procedures	YES:	No
Consent Forms	YES	No

For additional Information, please contact :

Dr. Ellen Toth at ellen.toth@ualberta.ca or at 780-407-6223