A primary care provider or specialist referral is required.
Criteria
Referral Form
Level One (50% of diabetes population) means that routine care is provided by a primary care provider (family doctor, nurse practitioner, etc.)
Level Two (35% of diabetes population) patients receive assisted care since abnormal blood sugar levels may require some intervention but do not have any other related and continuing complications
Level Three (15% of diabetes population) require intensive case management – these are the services provided at the CCDC
The CCDC is different from other programs currently available in that it focuses on the care of Level Three patients only. Patients are discharged from the program when they are able to self-manage their conditions with support from a Level 1 or Level 2 program.
About the CCDC Program
The CCDC focuses on the care of Level Three patients only. The CCDC team use a collaborative approach to diabetes treatment, designing care plans to meet each patient’s individual needs. Patients are discharged from the program when they are able to self-manage their conditions with support from a Level 1 or Level 2 program.
The CCDC serves the largest land mass of the Province of Ontario (47%) coupled with the smallest and most dispersed population. In addition, the region has many small towns and First Nations communities located throughout rural and remote areas which makes planning, delivering, and accessing health services difficult. The CCDC is committed to overcoming these challenges through the use of virtual care and other innovative programming to help people living with diabetes who need Level Three services get quality care, and get that care closer to home whenever possible.
Our Team
The interdisciplinary team includes:
- Physician
- Nurse Practitioners
- Registered Nurses
- Dietitians
- Pharmacist
- Psychologist
- Social Worker
- Occupational Therapist
- Physical Therapist
- Foot care
- Wound care
- Phlebotomy
- Indigenous Navigator
Our Programs
Outpatient Program: Patients 18 years of age of older, with a new or existing diabetes diagnosis, who are experiencing struggles managing diabetes without access to specialized care are appropriate for the CCDC outpatient program. Outpatient referrals from across the region are accepted from physicians, nurse practitioners or specialists.
We provide two outpatient routes:
- An individual track where patients will be booked for one to one appointments with practitioners. This provides more time for individual education and support.
- A multiclinic track where patients see members of the team in a single appointment that occurs with multiple team members. This allows patients to see more of the team with less clinic visits
We offer several groups for patients attending our outpatient program:
- Program Orientation
- Living well with Diabetes
- Mindfulness
- Feet and Physical Activity
- Seasonal Programming
Inpatient Program: As blood sugar control is often disturbed during periods of unrelated illnesses and hospitalization, the CCDC offers an inpatient program for admitted patients of TBRHSC. Upon referral from a hospital physician, our Registered Nurses and Dietitians provide diabetes management services and education to patients during their admission. At discharge patients are referred to the most appropriate outpatient diabetes care practitioner to meet their needs.
What to Expect
If you have been referred to the CCDC, the interprofessional teams will provide you with specialized care geared towards your specific needs. You will work with one or more team members to assess your current condition, discuss strategies to help you achieve your diabetes related goal and receive support as you work towards these. When you have achieved your goals, you will graduate and your care will be transferred back to the care of your primary care provider or an alternate program.
What to bring to appointments:
- A list of questions you may have
- A pen and paper
- Friends or family who support you with managing your health
- Your blood glucose meter or logbook
- A list of medications or update us of any changes
- Your Health Card
If you cannot make your appointment for any reason, please call the CCDC at 807-684-6944.
In order to provide access and shorter wait times for all, multiple missed appointments will result in a discharge from CCDC.
