The nine Coast Salish and Nuu-Chah-Nulth nations of southern Vancouver Island have supported diabetes prevention and management with a variety of programs; however, the rate of diabetes continues to rise. Our goal is to engage with the nine First Nations communities through one-day gatherings to identify the assets, experiences, barriers, and gaps within each community, and integrate culture and language into a community-led model for diabetes prevention, treatment and management. We aim to co-create a framework for a diabetes prevention and care model that is community-driven, improves diabetes services at the local level, and supports nation-based self-determined approaches to diabetes prevention and management. It is imperative that we prioritize this work and align our efforts to explore a collaborative, decolonized approach to diabetes care. Our model will enhance the culture and resilience that is already present within our communities and bridge gaps in care to develop a diabetes strategy that can support our question of “How can we be who we are as First Nations people while integrating our Traditional knowledge with the best of Western approaches to diabetes care?”.
Team members: Valerie Bob (Simon Fraser University); Gwen Underwood (Saanich First Nations Adult Care Society); Marie Va’a (Tsartlip First Nation); Emily Doehnel (Tsartlip First Nation); Lois Williams (Tsawout First Nation); Kelli Telford (Tseycum First Nation); Kinsey Goertz (Tseycum First Nation); MaryAnn Daniels (Pauquachin First Nation); Jessie Jim (Songhees Nation); Hayley Moreau (Songhees Nation); Chris McElroy (Songhees Nation); Jeneen Hunt (Esquimalt Nation); Stephanie McMahon (Esquimalt Nation); Krista Johnny (Scia’new First Nation); Angie Gibson (Scia’new First Nation); Rose Dumont (T’sou’ke Nation); Jennifer Routhier (T’sou’ke Nation); Grant Robinson (Island Health); Penny Cooper (Island Health); Ashley Simpson (University of Victoria); Jennifer Murray (UBC); Brenda Bartleman (Tsartlip First Nation); Judith Atkin (Island Health); Amanda Henry (Island Health); Carol Hill (Pacheedaht Nation); Tara Claxton (Pacheedaht Nation); Rachel Dickens (Nuu-Chah-Nulth Tribal Council); Mathew Dueck (First Nations Health Authority)
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Co-lead:
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Team members:
- William Cunningham
Island Health
- Patti Telford
Nurse & Nurse Practioners of BC
- Zachary Matieschyn
BC Ministry of Health
- Christina Berlanda
Island Health
- Shelley Tice
Island Health
- Danielle Daigle
Nurse & Nurse Practioners of BC
- Angela Wignall
Island Health
- Jinelle Woodley
Island Health
- Steve Goodchild
Island Health
- Brenda Warren
Island Health
- Leanne Rowand
Main Island Health Centre
- Lorine Scott
FNHA
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Nurse Practitioners (NPs) have practiced in BC since 2005, and are qualified to provide holistic primary care across the life span, similar to primary care physicians. Until 2018, NPs were health authority employees in salaried positions; in 2018 the MOH announced 200 new community NP positions and a contract payment structure option. Numerous contracted NP positions have since been introduced in Island Health. Integrating contracted NPs into an established primary care model traditionally provided by doctors has exposed unique challenges, opportunities and unintended outcomes. Although all stakeholders have generally worked well together, unanticipated conflicts and inefficient work flow impacts have arisen. Integrating inter-professional scopes of practice into an efficient and seamless system of innovative primary care in context of mixed expectations has been challenging. Published evidence suggests that full NP role optimization is affected by practice environments. We aim to develop a research plan to identify the enablers, challenges and unexpected outcomes, and determine how innovative processes enabling focused collaboration, clear scope of practice and improved teamwork can improve flow and access in primary care.
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Co-leads:
- Christine Lee
Island Health
- Katharine McKeen
Victoria Division of Family Practice
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Trainee:
- Jocelyn Chai
University of British Columbia
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Dr. Christine Lee and her research co-lead Dr. Katharine McKeen, a primary care physician (PCP) with the Victoria Division of Family Practice (DFP), are employing a patient-oriented research (POR) approach to raise awareness and disseminate evidence of fecal microbiota transplant (FMT) to treat recurrent Clostridium difficile infection (rCDI). FMT, the administration of feces from a healthy screened donor, is demonstrated to be both safe and more effective than the usual ways to treat rCDI. Estimates from three recent Canadian studies indicate that only 1,000 rCDI patients have received FMT, yet approximately 10,000 Canadians each year are diagnosed with rCDI.
The team is proposing a distributed knowledge translation approach, one that will enable them to reach diverse stakeholders: patients, families, PCPs, and healthcare decision makers (HCMs). Using a POR approach, they will co-develop a digital story that will enable their patient partner to share her lived experience of rCDI and FMT, and then the research team will relay the evidence for FMT. This video will be used for public outreach and as an education tool. They will also engage PCPs and HCDMs through presentations at their respective networks. During this outreach, the digital story will be displayed.
The overall goal is to increase FMT access for patients diagnosed with rCDI. The objectives are to:
- Raise awareness of rCDI and FMT.
- Inform stakeholders of FMT’s safety and effectiveness.
- Engage PCPs and HCDMs in a constructive dialogue to discuss the benefits of and evidence for FMT for rCDI.
The expected outcomes and outputs are to:
- Raise stakeholder awareness of FMT and its benefits as a treatment for rCDI. Output: Production and launch of a digital story telling video on rCDI and FMT as an education and public awareness tool.
- Foster communications with PCPs and increase their awareness of regional FMT resources. Output: Share the digital story and engage PCPs in a constructive dialogue via a café scientifique style discussion at the DFP “Dine and Learn” session.
- Increase HCDMs awareness of regional FMT resources and FMTs positive contributions to the healthcare system overall. Output: Share the digital story and engage HCMs through presentations to Island Health's Medical Advisory and Clinical Practice Councils.
The team will evaluate the impact of their work by using the domains of the Canadian Academy of Health Science “Making and Impact” framework: advancing knowledge; research capacity building; informed decision making; health impact; and broad social and economic impact.
