Diabetes is a serious health concern for the American Indian/Alaska Native (AI/AN) population that SEARHC serves. In response to the increasingly high rates of diabetes in Southeast Alaska Natives, Southeast Alaska Regional Health Consortium (SEARHC) proposes to provide a multi-pronged, integrated care team approach to addressing glycemic control, blood pressure management, foot care exams, and diabetes-related education and prevention programming.
SEARHC serves 18 Tribes across a remote 600-mile rainforest archipelago of islands covering 42,000 square miles in Southeast Alaska. Almost all communities are only accessible by boat or plane (no roads). The rugged geography results in high costs of living due to commodities being barged or air-freighted into the region. SEARHC operates a coordinated health care system with a regional hospital in Sitka, a medical center in Wrangell, a major outpatient facility in Juneau, and eleven clinics in remote village sites. Registered Nurse Diabetes Educators/Case Managers (DE/CMs) work in Juneau, Sitka, and Haines. Registered Dietitians will operate in two locations whilst providing services to the outlying communities via in-person diabetes clinic site visits, phone, and telehealth options. Health Educators are in two communities, providing individual and group education and activities both locally and virtually.
The SEARHC service population has a high need for a team-based, integrated care approach to support glycemic control, blood-pressure management, providing foot exams, and diabetes-related education. The Alaska Native Health Status Report (third edition) states that the statewide age-adjusted prevalence of Alaska Native people diagnosed with diabetes was 6.3% in 2019. Of the nine Alaska Service Units, the Mount Edgecumbe Service Unit (closely approximates SEARHC's service area) has the third highest diabetes prevalence rate. The 2020 Behavioral Risk Factor Surveillance Survey (BRFSS) found that state-wide 36.3% of AI/AN adults were obese. Obesity is a complicating factor for type 2 diabetes, elevated A1c, and hypertension.
SEARHC proposes to provide a community-clinical integrated care team to patients with diabetes to assist with glycemic control, blood pressure management, foot exams, as well as education and prevention programming for patients at risk of developing diabetes. For patients with diabetes, the DE/CMs and Dietitians will work with clinical staff to identify, screen, provide education, and case manage patients who require support in lowering their A1Cs and controlling their blood pressure. They will also work to ensure all diabetic patients receive comprehensive foot exams. DE/CMs and Dietitians will refer patients who need additional education to Health Educators and their programming. For patients at risk of diabetes, Health Educators will offer diabetes education and health behavior counseling individually and in group settings.
SEARHC has the expertise to successfully implement this program with SDPI funding. SEARHC is working to fill staff vacancies to ensure all key positions are filled. SEARHC is supporting staff in becoming Certified Foot Care Nurses (CFCN) to achieve grant objectives. SEARHC is investing in training for Health Educators towards the Chronic Disease Self-Management Program (CDSMP), and Diabetes Self-Management Program (DSMP) provided by the State of Alaska to strengthen our programming impact on participant health outcomes. SEARHC Health Educator is trained in the Diabetes Prevention Program (DPP).