Hundreds of thousands of Alaskans have or are at risk diabetes and heart disease. Alaska needs better adoption of evidence-based practices in healthcare and better access to self-management programs to help Alaskans optimally manage chronic conditions and improve their quality of life. Under this proposal, the Section of Chronic Disease Prevention and Health Promotion (CDPHP) will work with healthcare systems, providers, businesses, and payers to prevent and control heart disease and diabetes, with a special emphasis on underserved Alaska Native and low income populations, with a focus on hypertension and high blood cholesterol control, as well as diabetes prevention and self-management.
Heart disease is the second leading cause of death in Alaska. Because hypertension is a primary risk factor for heart disease, CDPHP has partnered with the Alaska Primary Care Association (APCA), a training and technical assistance organization serving federally qualified health centers (FQHC), to track and treat patients with hypertension. Roughly 30% of Alaska adults report having been told they have high blood pressure; among Alaska adults living below the federal poverty level, 42% report having high blood pressure. Although we don’t see the same disparities in prevalence of reported high cholesterol in Alaska (approximately 44%, regardless of race or income), Alaska Native people and Alaskans in poverty are less likely to be screened for, and be aware of, high blood cholesterol.
Diabetes mellitus is the eighth leading cause of death in Alaska. Prevalence has increased significantly over the past twenty years, with roughly 8% of adults in 2016 reporting ever having been diagnosed with diabetes. CDPHP manages a diabetes self-management education and support (DSMES) umbrella license to increase access to and participation in accredited programs. CDPHP also partners with the University of Alaska Fairbanks Cooperative Extension Service to offer chronic disease and diabetes self-management programs (CDSMP and DSMP).
Over the five-year project, CDPHP expects to achieve and report on the following short-term, intermediate, and long-term outcomes among Alaska adults age 18 and older who have prediabetes, diabetes, hypertension, or high blood cholesterol, including Alaska Native adults and low income adults.
In Category A, Diabetes Management, for people with diabetes:
• Increased access to and participation in DSMES.
• Increased use of pharmacist patient care processes that promote medication management.
• Increased access to DSMP and CDSMP.
• Increased participation in DSMP and CDSMP.
• Decreased proportion of people with diabetes with HbA1C > 9.
In Category A, Type 2 Diabetes Prevention, for people with prediabetes:
• Increased access to and coverage for the National DPP.
• Increased community clinical links that facilitate referrals and provide support to enroll and retain participants in the National DPP.
• Increased enrollment and retention in CDC-recognized organizations delivering the National DPP.
• Increased number of people with prediabetes enrolled in a CDC-recognized lifestyle change program who have achieved 5-7% weight loss.
In Category B, Cardiovascular Disease Prevention and Management, for patients with hypertension and high blood cholesterol:
• Increased reporting, monitoring, and tracking of clinical data for improved identification, management, and treatment.
• Increased use of and adherence to evidence-based guidelines and policies related to team-based
• Increased community clinical links that support systematic referrals, self-management, and lifestyle change.
• Increased medication adherence.
• Increased engagement in self-management.
• Increased participation in evidence-based lifestyle interventions.
• Increased control.