The TransFORmation of IndiGEnous PrimAry HEALthcare Delivery (FORGE AHEAD) program (2013-2019) was launched in response to the growing awareness and understanding of how type 2 diabetes impacts Indigenous populations in Canada. The FORGE AHEAD team is based at Western University, London, Ontario, they collaborated with different First Nations communities, health care providers, and academic researchers in order to develop action plans for diabetes prevention and clinical management. Together they developed and evaluated community-driven, culturally relevant, primary healthcare models to enhance chronic disease management and appropriate access to available services in First Nations communities across Canada. The program ensured culturally appropriate implementation and integrated knowledge translation by involving relevant stakeholders throughout the entire program.
The FORGE AHEAD research program incorporated a series of 10 inter-related and progressive projects designed to foster community-driven initiatives with type 2 diabetes mellitus as the action disease. Projects included both community & clinical readiness consultations, development of a diabetes registry & surveillance system, quality improvement activities, cost-analysis, and development of scale-up tool-kits.
Final Results
On November 4, 2019 a final meeting was held in Montreal for all participants to discuss the findings of the FORGE AHEAD Program. There was an open discussion with questions and answers with regards to overall clinical results, did the results have some reflections of their communities experience and was there something unique or unexpected that caught their attention.
The Clinical Outcomes Summary showed the following:
- significant decreases in HbA1c, BP, LDL with individuals not meeting T2DM clinical targets at baseline
- significant increases in frequency of measurement of HbA1c, BP, LDL, ACR, eGFR
- community members were 51% more likely to have received at least 75% of guideline recommended services
It was found the QI approach and tools implemented within the FORGE AHEAD Program have potential in improving diabetes clinical outcomes.
