Renal outreach clinic makes difference in fight against diabetes

With an astonishing 15 per cent of Siksika residents suffering from diabetes, Melvin (Tyler) White, CEO for Siksika Health Services, knew something had to be done to prevent kidney disease or slow down its progression.

Now, eight years after Alberta Health Services brought its weekly renal outreach clinic to Siksika First Nation, over 100 people are being seen.

“The need to prevent the complications from diabetes early, to prevent the development of kidney failure, was the reason this program started. The focus was on management of patients in their home communities in contrast to most specialty clinics, which are only run in large cities,” said White, who gave the province the go-ahead to operate on Siksika, although First Nation health care falls under the jurisdiction of the federal government.

Nephrologist Dr. Brenda Hemmelgarn and Nurse Practioner Ellen Novak helped develop the outreach clinic for the Southern Alberta Renal Health Services.

“Aboriginal people are at high risk of developing kidney disease because there is a high prevalence of diabetes among this population,” said Novak.

Siksika is one of the top three communities in Alberta with the highest rate of diabetes.

Health Canada estimates Type 2 Diabetes rates are three to five times higher among First Nations people on reserves than among all other Canadians accounting for at least 90 per cent of diabetes cases.

Initially, the renal outreach clinic was run by a nurse, who would assess high-risk patients and communicate with a physician for medication changes and suggestions on management. The nurse would then implement the suggestions.

“Over time, we found that the communication…was delayed and patients were not receiving optimal care,” said Novak.

That realization prompted changes and since 2006, Novak has been assessing patients in the clinic independently and managing their blood pressure, diabetes and cholesterol, either making the necessary medication changes or initiating medications independently.

“I consult Dr Hemmelgarn as needed,” said Novak.

Patients requiring specific nephrologist expertise are referred by Novak to Hemmelgarn, who visits the clinic a few times a year to work with difficult cases.

Siksika has expanded services to the reserve schools with the assistance of pediatric nephrologist Dr. Susan Samuel. A school screening project identifies markers and risk factors for kidney disease and diabetes in school children.

“Research has shown us that if we manage patient’s blood pressure, cholesterol and diabetes and reach suggested targets, we can prevent kidney disease,” said Novak.

White noted they hope to expand the program to other First Nation communities. That expansion has already begun with Standoff, in the Blood First Nation, the newest site for a renal outreach clinic.

Said White, “I would definitely recommend this program to other First Nations wanting to make a difference and prevent this disease for future generations.”