There is growing evidence that investing in home care saves money while improving care and quality of life for people with chronic illnesses. Management of hypertension prevents cardiovascular disease and progression to ESRD particularly in people with diabetes. The First Nations population has a much greater incidence of diabetes and risk factors than the non-native population (shown in previous studies, DREAM 1 and 2).

The DREAM 3 study is designed to demonstrate the effectiveness of a First Nations nurse-administered treatment program using evidence-based guidelines in diabetic and hypertensive people at high risk of kidney disease. The study’s main focus is controlling hypertension to prevent progression of kidney disease. The study is divided into 2 categories, treatment arm where participants receive prescriptions for BP treatment according to an algorithm from the home care nurse and usual care arm where participants who require additional BP control are referred to their family physician. Home care nurses provide health and BP assessments to both groups during scheduled visits monitoring the patient’s progress.

To date, 90 participants have been enrolled and randomized to either group through Battleford Tribal Council Indian Health Services (BTCIHS). The baseline data is as follows (mean ±s): Age, 56(±12.64) yrs; Gender, 28 male participants, 46 female participants; BP, 151/96(±18.01/9.61) mmHg; Heart Rate,
81(±9.98) beats/min; Waist/Hip ratio, 0.99(±0.07); BMI, 33.2(±7.4) kg/m²; Creatinine, 70 (±16) umol/L; Total Cholesterol, 5.1(±0.93) mmol/L; HDL, 1.2(±0.4) mmol/L; LDL, 2.7(±0.9) mmol/L; Triglycerides, 3.3(±1.9) mmol/L; HBA1C, 7.6 (±2.6); Microalbuminuria/Creatinine ratio, 21(± 40.4); K+, 4.1(±0.4) mmol/L; Hemoglobin, 140(±15) g/L and Blood Sugar, 10.0(±4.9) mmol/L.

In summary, the baseline data demonstrates that this group with diabetes and hypertension is quite homogeneous and at high cardiovascular risk. DREAM 3 will evaluate whether a physician-supervised, home care nurse-administered, evidence-based treatment regimen reduces BP significantly between the groups. In addition changes from baseline in all parameters will provide evidence of a benefit of the overall nurse intervention on multiple risk factors. DREAM 3 may therefore provide information on a more rational means of providing health care.

DNC

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