Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics Within an Urban Alaska Native Health Care Setting

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PROJECT SUMMARY/ABSTRACT – RP1 Alaska Native and American Indian (ANAI) people are at increased risk for diabetes (DM) with documented prevalence of risk factors. Recent studies show that DM prevalence and incidence are rising and rates of pre- DM among the ANAI population in Alaska are as great, if not greater, than other U.S. groups. Additionally, 40% of DM is undiagnosed, thus increasing risk for DM complications. Since DM complications begin to develop during pre-DM, early screening and intervention can prevent or delay DM onset and its complications. “Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics within an Urban Alaska Native Health Care Setting” is a 4-year study that will use implementation science frameworks to assess acceptability, applicability, feasibility, and consequences of DM testing within Southcentral Foundation (SCF) Dental Clinics. SCF is a Tribal health organization providing primary care and dental services to ANAI people living within the urban Anchorage, Alaska area – home to nearly half of the ANAI population statewide. Research indicates that in a given year, 27% of adults who do not have contact with a medical provider did visit a dental provider. The well-documented bidirectional relationship between DM and periodontal disease suggests that dental visits offer a largely untapped opportunity to screen persons at risk for DM and refer them to primary care providers for follow up and treatment. This opportunity is enhanced at SCF because dental and primary care services are provided within the same closed Tribal health system. We propose a within-site post design, and phased approach to study the implementation of an evidenced- based preventive service – DM screening, brief intervention, and referral to primary care – delivered in a novel setting, dental clinics. Experienced clinical and implementation research experts will work with multiple stakeholders using two theoretical and complimentary dissemination and implementation science frameworks: Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and the Consolidated Framework for Implementation Research (CFIR) to accomplish three specific aims (SAs): SA1: Identify barriers and facilitators to implementing a diabetes screening and referral service within SCF Dental and Primary Care Clinics. SA2: Develop a dental clinic diabetes screening and referral service that minimizes barriers and utilizes facilitators identified in SA1. SA3: Pilot, assess, and iteratively refine a diabetes screening and referral service delivered through SCF Dental Clinics.