Local Impact - Michigan

Rebecca Price - Pokagon Band of Potawatomi
Pokagon Health Services Special Diabetes Program for Indians

The Pokagon Band of Potawatomi Indians began their Special Diabetes Program for Indians (SDPI) program in 1998. Before SDPI there was very little staff, and no health education or screening for diabetes was performed. The Pokagon Health Services (PHS) was in an acute-care phase that only served patients by assisting financially for medical care after diabetes had severe effects on their bodies. There was no screening equipment, or education for patients on self-care. Patients were spread throughout the 10 county service area and seeing many different providers. Today, the Pokagon Band of Potawatomi has their very own clinic and two (2) of the three (3) providers are Tribal citizens. In the beginning, many Tribal citizens were unaware of having a diabetes diagnosis because they didn't feel sick, or didn't follow through after being diagnosed. It was not unusual to see a hemoglobin (Hgb) A1c in double digits. [The A1C test gives you a picture of your average blood glucose (blood sugar) control for the past 2 to 3 months. Read more here.] Citizens didn't understand what an Hgb A1c was or what it meant. Many did not understand why or how diabetes was impacting their bodies, due to the fact that they were fearful of visiting a doctor or hospital.

Most of the patients had to learn from the beginning. It took time to gain their trust. As a Tribal member and one of the Community Health Nurses (CHN), Ms. Rebecca Price, found this to be challenging. Rebecca says that it took time for the community to accept the CHN’s help, even if they were Tribal members themselves. The CHN’s now screen patients for Type II diabetes, educate the community, and follow up with diagnosed patients after medical appointments. Rebecca reports that it is now unusual to see a Hgb A1c above a 9% [the American Diabetes Association suggests a 7%].

In 1998, PHS was in the beginning stages of using the Resource and Patient Management System (RPMS) and manually entering data. Rebecca reports that the CHN’s were using paper charts for 653 patients that had to be entered into the RPMS database. She says that 373 of the patients were under the age of 10 years old. Eighty five (85) of the patients were diabetic. The CHN’s screened and diagnosed nine (9) new patients with diabetes at this time. Over the years, and with funding through the SDPI, PHS has been able to hire more staff, acquire more diabetes equipment, purchase more medicine and create the diabetes education materials needed to teach and help citizens understand their disease.

Rebecca Price, Community Health Nurse Supervisor, Diabetes Coordinator, answers the following questions about the Pokagon Band of Potawatomi’s Special Diabetes Program for Indians (SDPI):

What kind of programming do you conduct to treat and prevent Type II diabetes in your Tribal community?

  • Diabetes screening within Pokagon Health Services (PHS) clinic on patients with diabetes and those at high risk for diabetes by one of our three (3) clinic nurses.
  • Diabetes labs can be drawn within our lab department by the clinic’s on-site phlebotomist.
  • PHS pharmacy offers many diabetes medications and insulin prescribed by the primary care providers.
  • PHS offers every patient diagnosed with diabetes a free glucometer and screening supplies with "on the spot" instructions from the pharmacist.
  • Podiatry screening and care by a podiatrist 4-6 days a month.
  • Therapeutic shoe dispensary program for all diabetic patients.
  • Education from the registered dietician on healthy eating, meal planning and cooking for the whole family.
  • In-home screening, education and treatment if referred by a Community Health Nurse (CHN).
  • Physical activity and exercise events for youth and adults within the Wellness Fitness Center.
  • Whirlpool treatments for patients with diabetes, wounds and poor circulation.
  • Family health fairs.
  • Breast feeding program where we loan out electric breast pumps and every new mother receives support and education from a Certified Lactation Nurse.

Has SDPI contributed to cost-savings for your health program? If so, how?

Cost saving is always a major goal in Indian country. We have been able to supply many things for our patients at the Pokagon Health Service including glucometers, medications, podiatry care and treatment. We have been able to prevent amputations due to the services provided at the podiatry clinics. The therapeutic shoe program ensures each diabetes patient has a well-fitted shoe or orthotic to prevent wounds and skin break down. Our nurses at the podiatry clinics are regularly checking and assessing patients’ feet and circulatory system. With less hospital stays due to amputations and wound specialty care not needed, I cannot begin to estimate our savings throughout the years.

We were able to increase the hours of the podiatry clinic. We offered more exercise and activities focusing on the youth. We have set programs in place geared towards prevention, starting with pregnant and new mothers and infants. Our breast feeding program has gained much attention and we've been able to put together a lactation room within the clinic for moms when they visit.

What are your plans to sustain the SDPI program?

We are in the process of enhancing our billing program, so we can bill for specialty treatments and procedures. Also, we rely more now on non-medical based treatment and prevention activities such as lactation education, registered dietitian fitness activity orders and prescriptions, and diabetes one-on-one education. Nurses can receive "Foot Care Certifications" and then provide foot care outside of the podiatry clinic. Many services can be billed that we are not billing for yet, but once they are this revenue will go back into serving our patients with diabetes.

Is there anything else you would like to share about the program?

In November 2014, we opened our first new clinic building. We supply many services in our clinic so we can serve any eligible American Indian or Alaska Native that walks through our door. Our diabetes patients have access to a full pharmacy with one (1) pharmacist and three (3) pharmacy technicians. Our Dental Department has four (4) dental chairs, two (2) dentists, and three (3) dental hygienists. In the Behavioral Health Department, we have five (5) counselors. In the Community Outreach Department there are three (3) nurses, a Masters Medical Social Worker, a wellness fitness center, four (4) transportation specialists, a registered dietician, and an optical program. We also have three (3) primary care providers, three (3) nurses and one (1) medical assistant, including the contracted podiatrist who is also a wound care specialist. We now have much to offer our Tribal community thanks to the continued funding of SDPI and other programs.

Stories & Progams

Diabetes Program Participants
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Diabetes Care Providers
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