Introduction I have 15 minutes to show you about 24 slides. Instead of cutting some out I will just run them through quickly because I think they tell the story themselves. Essentially, I will show you some numbers and plots describing why we need rural research, describe a research project that shows good quality clinical research can also take place in small rural towns, it is not just a privilege of the large academic urban centre anymore, And if I have time, I would like to describe at the end what need to occur to make rural research a constant in rural practice
This one slide tell you right away why we need more capacity for rural health research in SWO CVD is much higher in all rural areas that surround London.
Prevalence of HTN is also higher in rural compared to London
The prevalence of diabetes is much higher in some rural communities than in the city. The rate of DM in Grey Bruce is twice the rate in London, which is similar to the provincial and Canadian average In Huron county is about 50% higher
The prevalence Obesity is about 30% higher in Huron County compared to London, Obesity is a major problem affecting rural communities everywhere in developed countries. It used to be rural residents were more fit than the city residents, now it is the opposite And this is very important because Obesity is the underlying cause of lots of Diabetes and CVD, so this is a big problem no pan intended
Obesity is responsible for the global epidemic of diabetes The number of people with diabetes will double within 20 years if we don’t do something now !
Type 2 Diabetes used to be seen almost exclusively in older groups but now we see it more and more at younger age because of child obesity
This is phenomenon that is predicted to happen if we don’t take action on obesity or lifestyle. It is predicted that the prevalence of CVD is going to rebound mainly due to the problem of overweight and child obesity Child obesity is responsible for the rebound in CVD expected to begin anytime now. The gains achieved over the last 40 or 50 years could easily disappear because of obesity, especially child obesity. This problem has a lot of academic investigators worry, and also governments…no health care system could afford to have the rates of CVD we have in the 60s or 70s. It is also worrying that the age of heart attacks will occur at much younger age, not at age 60 or 70 like then but at age 40 and early 50s. So, the high rates of obesity and especially child obesity is a major public health problem, we need to find ways to fight his epidemic. But who are the professionals that need to deal with this problem? What is the setting?
Traditionally CR takes place at the urban academic tertiary centre, but this may not be the best setting to deal with the problem of obesity. Probably you would agree that the experts are the health professionals that see this patients day in and day out and those are the frontline physician, the community nurse, dietician and pharmacist The research need to take place at this level
And that is what we are doing in Seaforth, Is building capacity for community-based research Seaforth is a perfect to build a research centre, very dynamic vibrant and engaged community Next I’m going to show an example that good quality research can be done in rural Ontario,
This is our first study and we are very proud of it, It was done in partnership with a group from the Lawson RI Essentially it was a pilot study to test how the use technology can help with a program designed to increase physical activity on patients at risk of developing diabetes and CVD.
This are the guidelines from the American College of Sports Medicine (ACSM) WE ask the patient to aim for 10K steps daily
A very unique feature of this study was the use of cutting edge technology for the purpose of home monitoring of BP Sugar levels, pedometer and weight. The system has a device that allows you to have the information you need about your health right in your hands…
This is a pedometer…it measures the number of steps you have taken throughout the day. This is the most important gadget of all. If you wore one of this it will increase the chances that you will park your car far away from the door… It is very useful. Can I have a show of hands for the people here who have one of this, Great, just a few. My advice, order one and use it… you will see now why that is important
The next 4 slides are just to illustrate a proposal we are working on at Gateway that I believe if implemented it can help to address some of these very important issues. Essentially, Is about building capacity for: - rural health research - teaching and training rural health professionals
Lets talk about the current model.
Munzo Gateway Rural Health Resh Institute
The DaTA Study: A success story Claudio Munoz MD,PhD Scientific Director
Source: Canadian Institute for Health Information Huron County
Percentage of people with high blood pressure Stats Canada, Canadian Community Health Survey 2005
People with diabetes Stats Canada, Canadian Community Health Survey 2005
Obese Adults (18+) with BMI > 30 Stats Canada, Canadian Community Health Survey 2005
D iabetes a nd T echnology for increased A ctivity: DaTA Study <ul><li>To assess the use of technology as an intervention to increase physical activity in subjects with metabolic syndrome, risk factors for type 2 diabetes and cardiovascular disease and to improve cardiovascular health </li></ul>
American College of Sports Medicine (ACSM) Guidelines
Diabetes Prevention Program Research Group. NEJM 2002:346-393
Rural Health Issues <ul><li>Shortage of rural health professionals </li></ul><ul><li>Health disparities between rural & urban </li></ul><ul><li>Insufficient infrastructure for: </li></ul><ul><ul><li>rural health research </li></ul></ul><ul><ul><li>community-based clinical research </li></ul></ul><ul><li>Insufficient teaching capacity in rural health </li></ul>
Rural Health Centre PRECEPTOR Student <ul><li>Informal </li></ul><ul><li>Inconsistent </li></ul><ul><li>Take time away from patients </li></ul><ul><li>Insufficient exposure </li></ul><ul><li>Too few students </li></ul><ul><li>No time for research </li></ul>Is this model appropriate?
Academic Rural Health Centre Rural Clinical Professor Student Student Student Resident Rural Medicine <ul><li>Increase teaching capacity </li></ul><ul><li>Academic credentials </li></ul><ul><li>Resident as clinical resource </li></ul><ul><li>More time for: </li></ul><ul><ul><li>Professional development </li></ul></ul><ul><ul><li>Research </li></ul></ul><ul><ul><li>Community service </li></ul></ul><ul><li>Recruitment tool </li></ul>
Integrated model for rural health research and education Gateway
Inter-professional education for rural health Interdisciplinary patient care