Study of Surrey’s middle aged and older South Asian population leads to changes in clinical services to prevent illness and chronic disease.

Surrey’s South Asian population is about 170,000 or 30 percent of the overall population. Data shows chronic and sometimes fatal diseases, such as diabetes, cardiovascular disease and kidney disease, are much more common among BC’s South Asian population than the overall population. For example, the diabetes rate is estimated to be twice as high for the South Asian population.

From October 2014 through February 2015, a study of the middle aged and older South Asian population took place to help identify what the facilitators and barriers were for clinical prevention services such as the flu shot, colorectal screening or blood pressure testing for cardiovascular disease. The Surrey Hospital & Outpatient Centre Foundation funded the study, and Fraser Health’s Chief Medical Officer and Vice-President of Population Health, Dr. Victoria Lee, was principal investigator. Other members of the research team included Dr. Kendall Ho, Dr. Arun K. Garg, Gary Thandi, Rachel Douglas and Sanaa Majid.

The study received input from 62 South Asian adults (36 women and 26 men aged 40-87) through focus groups held in the community. Participants were asked what made it easier or more difficult to access clinical prevention services.

“The research team has been able to inform some changes to where and how clinical prevention services are provided and is continuing to work on larger system-level changes,” says Rachel Douglas, evaluation specialist, population and public health. A couple of the key findings were that participants reported they did not know that these preventative services were recommended or that they didn’t feel that there was enough time during doctor’s visits to discuss prevention along with more pressing health problems.

Successfully moving their findings into practice started with how the team approached the study design. “We met with Fraser Health’s Diversity Services and several non-profits that Fraser Health partners with to serve the South Asian community to get their perspectives on whether the questions and the design of the study were culturally appropriate and whether the logistics were feasible for the population,” says Rachel. “We know that when people are engaged in research from the beginning, it increases the likelihood that it will be moved into practice.” This was further demonstrated by the make-up of the research team with three South Asian members and two members from non-profits serving the South Asian population.

Having leaders on the research team who are program decision makers, such as Dr. Lee and Dr. Arun K. Garg who’s Director of Fraser Health’s South Asian Health Institute, helped inform the study as well as move its findings into practice. Dr. Lee had been on the BC-wide Clinical Prevention Policy Review Committee that had identified a Top 10 list in 2009 of clinical prevention services BC’s health authorities should focus on to have the greatest impact on improving population health and reducing health care costs. “The research team has used this list for all aspects of our study from design, to conversations with study participants to moving the research to practice,” says Rachel.

At the same time as the study, Dr. Lee and Dr. Garg were involved with a new South Asian Health Institute program called Sehat. Sehat uses volunteers in the community to connect people with clinical prevention services such as glucose testing and vaccinations as well as other health services and information now offered right at temples and other community hubs where people gather. “We were well positioned to use the research results to inform the Sehat program as both Dr. Garg and Dr. Lee were leading the development of the program,” says Rachel. “It’s had a positive impact. We heard from the program manager that the research results were very useful and that they heard similar stories from their program participants.”

To help other clinical prevention providers understand how they can change practices to better serve the South Asian population, the research team carried out informal presentations in late 2015 and early 2016. These included a Researcher’s Café for planners and managers at Central City and Lunch and Learns for doctors and nurses at the Jim Pattison Outpatient Care & Surgery Centre and Surrey Memorial Hospital, the latter also being offered by webinar. “We had great discussions with lots of enthusiasm for future collaboration, and we took the extra step of creating two-page handouts tailored to their particular needs,” says Rachel.

Examples of formal sharing of the research results include a presentation at the 2015 national Family Medicine Forum, presenting to the Fraser Health Clinical Operations Committee in July 2016, having an article published in Canadian Medical Association Journal Open in August 2016, presenting to the Prevention working group of the General Practice Services Committee in Sept, 2015 who recommended a meeting with the interdivisional council that has members from the region’s Divisions of Family Practice as well as Fraser Health executives.

Making system-level changes so standard visits to a family doctor can be longer was the most significant recommendation of the study participants. The researchers would like to learn more about this approach and other study findings and are continuing to pursue opportunities to do so. “We’ve been invited to present in 2017 to the interdivisional council and we’re very much looking forward to this to explore next steps and whether there is interest in an implementation research project based on some of our study’s recommendations for primary care transformation,” says Rachel.

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