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Ziegler D, Burow S, Landgraf R, Lobmann R, Reiners K, Rett K, Schnell O. Current Practice of Podiatrists in Testing for Diabetic Polyneuropathy and Implementing Foot Care (PROTECT Study Survey 2). Endocr Pract 2024:S1530-891X(24)00561-5. [PMID: 38880347 DOI: 10.1016/j.eprac.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
AIMS Podiatrists constitute a key member of a multidisciplinary foot care team, but their services remain underutilized. We sought to gain insights into the daily practice of podiatrists focusing on screening for and monitoring of diabetic sensorimotor polyneuropathy (DSPN) as well as foot management. METHODS This cross-sectional survey included 125 podiatrists from 12 federal states across Germany who responded to an online questionnaire. RESULTS The majority of patients treated in podiatry practices were referred by general practitioners and diabetologists. Screening for or follow-up of DSPN was performed by 36% of the respondents at least once a year, by 28% only at initial examination, by 21% only at suspicion, and by 10% basically at each treatment visit. Instruments to assess vibration, touch/pressure, and temperature sensation were used by 81% to 94% of the podiatrists. Previously undiagnosed DSPN and foot ulcers were detected frequently/very frequently (≥6 cases/mo) by 24.0 and 18.4% of the podiatrists, respectively. Almost all podiatrists advised daily self-monitoring of feet and appropriate foot care and >50% gave advice on medical treatment. CONCLUSIONS Podiatrists play an important role in the detection, monitoring, and management of both DSPN and diabetic foot ulcers, suggesting that the utilization of their services should be fostered.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
| | - Sindy Burow
- Deutscher Verband für Podologie (ZFD) e.V., Kassel, Germany
| | | | - Ralf Lobmann
- Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Stuttgart, Germany
| | | | | | - Oliver Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center Munich, Neuherberg, Germany
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Andrikopoulou E, Chatzistergos P, Chockalingam N. Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e54852. [PMID: 38656782 PMCID: PMC11079765 DOI: 10.2196/54852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. OBJECTIVE This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. METHODS This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. RESULTS The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. CONCLUSIONS This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54852.
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Affiliation(s)
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
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Ju W, Al-Busaidi IS, Lunt H, Hudson B. Patient perceptions of barriers to attending annual diabetes review and foot assessment in general practice: a qualitative study. J Prim Health Care 2024; 16:53-60. [PMID: 38546785 DOI: 10.1071/hc23081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/04/2023] [Indexed: 04/02/2024] Open
Abstract
Introduction Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results We identified three key themes demonstrating barriers to attendance: healthcare-associated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action.
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Affiliation(s)
- William Ju
- Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand
| | - Ibrahim S Al-Busaidi
- Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand
| | - Helen Lunt
- Department of Medicine, University of Otago, Christchurch, New Zealand; and Diabetes Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Ben Hudson
- Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand
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Soonarane YK, Pollard G, Knack B, Hope M, Clark D, Naidu S, Anuradha S, Puri G. Inequity of healthcare access for patients with diabetic foot disease: a retrospective study in south-east Queensland. BMJ Open 2024; 14:e074155. [PMID: 38238174 PMCID: PMC11148679 DOI: 10.1136/bmjopen-2023-074155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES Logan local government area (LGA) in Queensland has the highest diabetes prevalence (6.5%) within Metro South Health (MSH). The study aimed to determine the burden of, and equity of access to secondary healthcare, for diabetic foot disease (DFD) for Logan residents to better inform healthcare services planning. DESIGN A retrospective analysis of hospital admissions data between January 2018 and December 2021. SETTING, PARTICIPANTS All episodes of care for DFD provided by MSH hospitals to patients with a residential address in the three LGAs serving the region were included. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was number of episodes of care for DFD by LGA of residence and hospital of presentation. Secondary outcomes were DFD-related hospital occupied bed days and number of lower extremity amputations. RESULTS Among residents in the MSH region, almost half of all episodes of care (47%) and bed days (48%) for DFD were for patients residing in Logan LGA. 40% of episodes of care, 57% of bed days and 73% of lower extremity amputations for DFD for these patients occurred outside of Logan LGA. These findings led to the planning of an integrated model of care for DFD at Logan hospital to improve and make care available locally. CONCLUSIONS Our study suggests that Logan residents with DFD had poor access to care despite the highest burden. Analysing epidemiology of care for DFD with an equity lens and highlighting gaps in service delivery is paramount to addressing the inequity paradigm.
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Affiliation(s)
- Yudish Kumar Soonarane
- Metro South Public Health Unit, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Gayle Pollard
- Metro South Public Health Unit, Metro South Health Service District, Woolloongabba, Queensland, Australia
| | - Brent Knack
- Healthcare Improvement Unit, Clinical Excellence Queensland, Herston, Queensland, Australia
| | - Matthew Hope
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Darren Clark
- Division of Internal Medicine, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Sanjeev Naidu
- Department of Surgery, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Satyamurthy Anuradha
- Metro South Public Health Unit, Metro South Health Service District, Woolloongabba, Queensland, Australia
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Gaurav Puri
- Healthcare Improvement Unit, Clinical Excellence Queensland, Herston, Queensland, Australia
- Logan Endocrine and Diabetes Services (LEADS), Logan Hospital, Metro South Health, Meadowbrook, Queensland, Australia
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Pallin JA, Buckley-O'Farrell K, Riordan F, McGrath N, O'Neill K, MacLoughlin D, Dinneen SF, Buckley CM, McHugh S, Kearney PM. Implementing an integrated diabetic foot care programme in Ireland: podiatrists' experience. BMC Health Serv Res 2023; 23:1157. [PMID: 37884981 PMCID: PMC10601248 DOI: 10.1186/s12913-023-10144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND International evidence suggests that an integrated multidisciplinary approach to diabetic foot management is necessary to prevent ulceration and progression to amputation. Many health systems have introduced policies or models of care supporting the introduction of this evidence into practice, but little is known about the experiences of those involved in implementation. This study addresses this gap by examining the experiences of podiatrists providing integrated diabetic foot care. METHODS Between October 2017 and April 2018, an online survey comprising closed and open-ended questions on podiatrists' demographics, clinical activity, links with other services, continuous professional development activities and experiences of implementing the Model of Care was administered to podiatrists (n = 73) working for Ireland's Health Service Executive in the community and hospital setting. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS The response rate was 68% (n = 50), with 46% (n = 23), 38% (n = 19) and 16% (n = 8) working across hospital, community and both settings, respectively. Most reported treating high-risk patients (66%), those with active foot disease (61%) and educating people about the risk of diabetes to the lower limb (80%). Reported challenges towards integrated diabetic foot care include a perceived lack of awareness of the role of podiatry amongst other healthcare professionals, poor integration between hospital and community podiatry services, especially where new services had been developed, and insufficient number of podiatrists to meet service demands. CONCLUSION Previous evidence has shown that there is often a gap between what is set out by a policy and what it looks like when delivered to service users. Results from the current study support this, highlighting that while most podiatrists work in line with national recommendations, there are specific gaps and challenges that need to be addressed to ensure successful policy implementation.
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Affiliation(s)
| | | | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Niamh McGrath
- HRB Evidence Centre, Health Research Board, Grattan House, 67-72 Lower Mount Street, Dublin 2, Ireland
| | - Kate O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Sean F Dinneen
- School of Medicine, University of Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | | | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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Zhu X, Lee ES, Lim PX, Chen YC, Chan FHF, Griva K. Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care. Int Wound J 2023; 20:2764-2779. [PMID: 36970982 PMCID: PMC10410341 DOI: 10.1111/iwj.14153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Xiaoli Zhu
- Nursing ServicesNational Healthcare Group PolyclinicsSingaporeSingapore
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
| | - Eng Sing Lee
- Clinical Research UnitNational Healthcare Group PolyclinicsSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Phoebe X.H. Lim
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
| | - Yee Chui Chen
- Nursing ServicesNational Healthcare Group PolyclinicsSingaporeSingapore
| | - Frederick H. F. Chan
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
| | - Konstadina Griva
- Population/Global Health, Lee Kong Chian School of Medicine, NanyangTechnological UniversitySingaporeSingapore
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lashkarbolouk N, Mazandarani M, Mohajeri Tehrani MR, Aalaa M, Sanjari M, Mehrdad N, Reza Amini M. Fast-Track Pathway: An Effective Way to Boost Diabetic Foot Care. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231189048. [PMID: 37529303 PMCID: PMC10388609 DOI: 10.1177/11795514231189048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients' knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway's main objectives is to prevent the patient from getting the first ulcer, prevent frequent recurrence ulcers, and most importantly, prevent minor and major amputation.
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Affiliation(s)
- Narges lashkarbolouk
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mazandarani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Zhang M, Jin J, Liu Y, Ben C, Li H, Cheng D, Sun Y, Guang-Yi W, Zhu S. Analysis of povidone iodine, chlorhexidine acetate and polyhexamethylene biguanide as wound disinfectants: in vitro cytotoxicity and antibacterial activity. BMJ Nutr Prev Health 2023; 6:21-27. [PMID: 37559968 PMCID: PMC10407393 DOI: 10.1136/bmjnph-2022-000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/27/2022] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES Even though disinfectants are commonly used in clinical practice and daily life, there are few studies on their antibacterial ability and cytotoxicity, which are closely related to the safety and effectiveness of their use. To provide a basis for the use of disinfectants, the cytotoxicity and antibacterial activity of three most commonly used disinfectants, povidone-iodine, chlorhexidine acetate and polyhexamethylene biguanide (PHMB), were investigated. DESIGN A CCK-8 assay was used to measure the activities of human fibroblasts (HF) and keratinocytes (HaCat), the two most important cells in wound healing, following their exposure to disinfectants. The effects of different times and concentrations were included. The antibacterial activity of disinfectants against Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae was reflected by their minimum inhibitory concentration and minimum bactericidal concentration. RESULTS All three disinfectants showed strong cytotoxicity in direct contact with HF and HaCat cells. Cytotoxicity increased with increasing exposure time and concentration. S. aureus, A. baumannii and K. pneumoniae comprised 70%, 55% and 85% of the strains sensitive to povidone iodine; 50%, 45% and 80% of the strains sensitive to chlorhexidine acetate; and 60%, 45% and 80% of the strains sensitive to PHMB, respectively. CONCLUSIONS All three disinfectants were cytotoxic; therefore, it is necessary to pay attention to the use time and concentration in the clinical setting. All three disinfectants were cytotoxic, with povidone-iodine being the most cytotoxic even at low concentrations. PHMB had better antibacterial efficacy against S. aureus and is suitable for the treatment of shallow wounds primarily. All three tested bacteria were significantly more sensitive to PHMB than to the other disinfectants.
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Affiliation(s)
- Mingshi Zhang
- Department of Burns, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian Jin
- Department of Polymer Science, Fudan University, Shanghai, China
- Shanghai Depeac Biotechnology Co., Ltd, Shanghai, China
| | - Yingying Liu
- Department of Burns, Naval Medical University, Yangpu, Shanghai, China
| | - Chi Ben
- Department of Burns, Naval Medical University, Yangpu, Shanghai, China
| | - Haihang Li
- Department of Burns, Naval Medical University, Yangpu, Shanghai, China
| | - Dasheng Cheng
- Department of Burns, Naval Medical University, Yangpu, Shanghai, China
| | - Yu Sun
- Department of Burns, Naval Medical University, Yangpu, Shanghai, China
| | - Wang Guang-Yi
- Department of Burns, Changhai Hospital, Yangpu, Shanghai, China
| | - Shihui Zhu
- Department of Burns, Naval Medical University, Yangpu, Shanghai, China
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Zhao N, Xu J, Zhou Q, Hu J, Luo W, Li X, Ye Y, Han H, Dai W, Chen Q. Screening behaviors for diabetic foot risk and their influencing factors among general practitioners: a cross-sectional study in Changsha, China. BMC PRIMARY CARE 2023; 24:68. [PMID: 36907863 PMCID: PMC10009976 DOI: 10.1186/s12875-023-02027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Diabetic foot is a serious complication of diabetes with a high disability and mortality rate, which can be prevented by early screening. General practitioners play an essential role in diabetic foot risk screening, yet the screening behaviors of general practitioners have rarely been studied in primary care settings. This study aimed to investigate foot risk screening behaviors and analyze their influencing factors among general practitioners. METHODS A cross-sectional study was conducted among 844 general practitioners from 78 community health centers in Changsha, China. A self-designed and validated questionnaire was used to assess the general practitioner's cognition, attitude, and behaviors on performing diabetic foot risk screening. Multivariate linear regression was conducted to investigate the influencing factors of risk screening behaviors. RESULTS The average score of diabetic foot risk screening behaviors among the general practitioners was 61.53 ± 14.69, and 271 (32.1%) always or frequently performed foot risk screening for diabetic patients. Higher training frequency (β = 3.197, p < 0.001), higher screening cognition (β = 2.947, p < 0.001), and more positive screening attitude (β = 4.564, p < 0.001) were associated with more diabetic foot risk screening behaviors, while limited time and energy (β=-5.184, p < 0.001) and lack of screening tools (β=-6.226, p < 0.001) were associated with fewer diabetic foot screening behaviors. CONCLUSION The score of risk screening behaviors for the diabetic foot of general practitioners in Changsha was at a medium level. General practitioners' diabetic foot risk screening behaviors may be improved through strengthening training on relevant guidelines and evidence-based screening techniques, improving cognition and attitude towards foot risk screening among general practitioners, provision of more general practitioners or nurse practitioners, and user-friendly screening tools.
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Affiliation(s)
- Nan Zhao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- Department of Nursing, The Second Affiliated Hospital of Xi'an Jiaotong University, 710004, Xi'an, Shaanxi Province, China
| | - Jingcan Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.
| | - Qiuhong Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China.
| | - Juanyi Hu
- Xiangya School of Nursing, Central South University, 410013, Changsha, China
| | - Wenjing Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
| | - Xinyi Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
| | - Ying Ye
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- Xiangya School of Nursing, Central South University, 410013, Changsha, China
| | - Huiwu Han
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Weiwei Dai
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- Department of Stoma Wound Care Center, Xiangya Hospital, Central South University, 410008, Changsha, China
| | - Qirong Chen
- Xiangya School of Nursing, Central South University, 410013, Changsha, China
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McPherson M, Carroll M, Stewart S. Patient-perceived and practitioner-perceived barriers to accessing foot care services for people with diabetes mellitus: a systematic literature review. J Foot Ankle Res 2022; 15:92. [PMID: 36527060 PMCID: PMC9755774 DOI: 10.1186/s13047-022-00597-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Foot-related complications are common in people with diabetes mellitus, however foot care services are underutilized by this population. This research aimed to systematically review the literature to identify patient and practitioner-perceived barriers to accessing foot care services for people with diabetes. METHODS PRISMA guidelines were used to inform the data collection and extraction methods. CINAHL, MEDLINE, and Scopus databases were searched in March 2022 to identify original research articles that reported on barriers to accessing diabetes foot care services from the patient and/or practitioner perspective. Both quantitative and qualitative studies were included. The methodological quality of included studies was assessed using the Critical Appraisal Skills Program (CASP) tool for qualitative/mixed methods studies or the National Heart, Lung & Blood Institute (NHLBI) tool for quantitative studies. Following data extraction, content analysis was used to identify reported barriers. Themes and subthemes were presented separately for patient-perspectives and practitioner-perspectives. A narrative summary was used to synthesize the findings from the included studies. RESULTS A total of 20 studies were included. The majority of CASP and NHLBI criteria were met by most studies, indicating good overall methodological quality. Three predominant themes emerged from the patient perspective that represented barriers to accessing foot care services: lack of understanding, socioeconomic factors, and lack of service availability. Four themes emerged from the practitioner perspective: poor interprofessional communication, lack of resources, lack of practitioner knowledge, and perceived patient factors. CONCLUSIONS This study has identified a number of barriers to accessing foot care services from both the patient and practitioner perspectives. Although patients focused predominantly on patient-level factors, while practitioners focused on barriers related to the health care system, there was some overlap between them. This emphasizes the importance of recognising both perspectives for the future integration of policy changes and access facilitators that may help to overcome these barriers.
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Affiliation(s)
- Megan McPherson
- grid.252547.30000 0001 0705 7067Department of Podiatry, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Matthew Carroll
- grid.252547.30000 0001 0705 7067Department of Podiatry, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand ,grid.252547.30000 0001 0705 7067Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Sarah Stewart
- grid.252547.30000 0001 0705 7067Department of Podiatry, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand ,grid.252547.30000 0001 0705 7067Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Lai TC, McDaniel CC, Chou C. Diabetes management behaviors associated with depression in the U.S. Diabetol Metab Syndr 2022; 14:178. [PMID: 36419073 PMCID: PMC9685969 DOI: 10.1186/s13098-022-00953-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a lack of nationally representative evidence from the U.S. investigating the relationships between depression and diabetes management behaviors. Our study aimed to assess the associations between diabetes management behaviors and depression status, and to compare U.S. population-level percentages of diabetes management behaviors among patients with and without depression. METHODS A cross-sectional study was conducted using population-based survey data to assess patient-reported variables retrospectively. We used the Behavioral Risk Factor Surveillance System (BRFSS) data and included states in the U.S. that continuously adopted the diabetes optional modules in 2013, 2015, 2017, and 2019. We included U.S. adults (≥ 18 years old) with self-reported diabetes in our analysis. Main outcomes were diabetes management behaviors (i.e., self-check for blood glucose and feet sores/irritation, regular diabetes clinical visit, HbA1c check, professional feet check, and dilated eye examination) and lifestyle behaviors (i.e., exercise, smoking, and alcohol consumption). RESULTS Among the 74,011 respondents with diabetes, patients with depression had a higher likelihood of performing routine HbA1c checks (adjusted odds ratio (AOR) = 1.12; 95% CI 1.01-1.23) but had a lower likelihood to perform regular self-check for blood glucose (AOR = 0.91; 95% CI 0.84-0.99), receive professional feet checks (AOR = 0.87; 95% CI 0.79-0.95), and receive a dilated eye examination (AOR = 0.89; 95% CI 0.82-0.98). For lifestyle behaviors, patients with depression were more likely to smoke (No smoking (AOR) = 0.65; 95% CI = 0.59-0.72) and less likely to engage in sufficient exercise time (AOR = 0.69; 95% CI 0.63-0.75). There were no significant associations between depression and other behaviors, including self-check for feet sores/irritation (AOR = 0.99; 95% CI 0.92-1.08), regular diabetes clinical visit (AOR = 1.03, 95% CI 0.94-1.13), and alcohol consumption (AOR = 1.01, 95% CI 0.92-1.10). CONCLUSIONS The association between depression status and diabetes management behaviors varied. People with depression were positively associated with HbA1c checks. However, less uptake of other behaviors may indicate the needs for improvement in diabetes management.
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Affiliation(s)
- Tim C Lai
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA
| | - Cassidi C McDaniel
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA.
- Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan.
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12
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Li Q, Birmpili P, Johal AS, Waton S, Pherwani AD, Boyle JR, Cromwell DA. Delays to revascularization for patients with chronic limb-threatening ischaemia. Br J Surg 2022; 109:717-726. [PMID: 35543274 PMCID: PMC10364726 DOI: 10.1093/bjs/znac109] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Vascular services in England are organized into regional hub-and-spoke models, with hubs performing arterial surgery. This study examined time to revascularization for chronic limb-threatening ischaemia (CLTI) within and across different care pathways, and its association with postrevascularization outcomes. METHODS Three inpatient and four outpatient care pathways were identified for patients with CLTI undergoing revascularization between April 2015 and March 2019 using Hospital Episode Statistics data. Differences in times from presentation to revascularization across care pathways were analysed using Cox regression. The relationship between postoperative outcomes and time to revascularization was evaluated by logistic regression. RESULTS Among 16 483 patients with CLTI, 9470 had pathways starting with admission to a hub or spoke hospital, whereas 7013 (42.5 per cent) were first seen at outpatient visits. Among the inpatient pathways, patients admitted to arterial hubs had shorter times to revascularization than those admitted to spoke hospitals (median 5 (i.q.r. 2-10) versus 12 (7-19) days; P < 0.001). Shorter times to revascularization were also observed for patients presenting to outpatient clinics at arterial hubs compared with spoke hospitals (13 (6-25) versus 26 (15-35) days; P < 0.001). Within most care pathways, longer delays to revascularizsation were associated with increased risks of postoperative major amputation and in-hospital death, but the effect of delay differed across pathways. CONCLUSION For patients with CLTI, time to revascularization was influenced by presentation to an arterial hub or spoke hospital. Generally, longer delays to revascularization were associated with worse outcomes, but the impact of delay differed across pathways.
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Affiliation(s)
- Qiuju Li
- Correspondence to: Qiuju Li, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK (e-mail: )
| | - Panagiota Birmpili
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Hull York Medical School, Hull, UK
| | - Amundeep S Johal
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Sam Waton
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arun D Pherwani
- Vascular Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust & Department of Surgery, University of Cambridge, Cambridge, UK
| | - David A Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
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13
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Bouillet B, Meloni M, Ahluwalia R. Improving referral of patients with diabetic foot ulcer to specialised diabetes foot care units. J Wound Care 2021; 30:782-784. [PMID: 34644130 DOI: 10.12968/jowc.2021.30.10.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin Bouillet
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France; INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | | | - Raju Ahluwalia
- Department of Orthopaedics and King's Diabetes Foot Clinic, King's College Hospital, Denmark Hill, London, UK
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14
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Walton DV, Edmonds ME, Bates M, Vas PRJ, Petrova NL, Manu CA. People living with diabetes are unaware of their foot risk status or why they are referred to a multidisciplinary foot team. J Wound Care 2021; 30:598-603. [PMID: 34382842 DOI: 10.12968/jowc.2021.30.8.598] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM People with active diabetic foot disease should be rapidly referred by health professionals along a pathway of care to a multidisciplinary foot team. The aim was to investigate patients' self-reported understanding of their foot risk status and reasons for their referral to a multidisciplinary foot team. METHOD This seven-month service evaluation included consecutive newly referred patients. Participants completed a questionnaire which asked firstly about their understanding of their foot risk status, secondly about their pathway of care before presentation to the multidisciplinary foot team, and thirdly about their interest in diabetes-related foot education and preferred learning style. RESULTS There were 202 participants; 65% were male, mean age was 64±15 years (mean±standard deviation (SD)), 86% had type 2 diabetes, and mean HbA1c was 65±23mmol/mol (8.3±3.7%). Only 4% of participants knew their current foot risk status and 52% did not know why their care had been escalated to a multidisciplinary foot clinic. Participants with type 2 diabetes more readily expressed an interest in further foot education compared with participants with type 1 diabetes, (70% versus 29%, p=0.001). CONCLUSIONS These findings show that people with diabetes and foot disease are less aware of their foot risk status or why they are referred to a multidisciplinary team. Participants indicated a variable interest in further learning about foot complications. These findings indicate possible communication and educational barriers between patients and health professionals which may contribute to delayed presentation or suboptimal engagement.
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Affiliation(s)
- Daina V Walton
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Diabetes UK Clinical Champion 2017-2019
| | - Michael E Edmonds
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Department of Diabetes, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Maureen Bates
- Diabetes Foot Clinic, King's College Hospital, London, UK
| | - Prashanth R J Vas
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Department of Diabetes, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Nina L Petrova
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Department of Diabetes, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Chris A Manu
- Diabetes Foot Clinic, King's College Hospital, London, UK
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15
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Fu XJ, Hu SD, Peng YF, Zhou LY, Shu T, Song DD. Observation of the effect of one-to-one education on high-risk cases of diabetic foot. World J Clin Cases 2021; 9:3265-3272. [PMID: 34002135 PMCID: PMC8107901 DOI: 10.12998/wjcc.v9.i14.3265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is a common chronic disease, and its global incidence is on the rise. The disease is directly attributed to insufficient insulin efficacy/secretion, and patients are often accompanied by multiple complications. Diabetic foot is one of the most common complications of diabetes. Diabetic feet have ulcers and infections, which can eventually lead to amputation. Basic nursing care, such as lowering blood pressure and preventing foot skin infections in clinical nursing work, has positive significance for the prevention and control of diabetic feet.
AIM To explore the positive significance of one-to-one education in high-risk cases of diabetic foot.
METHODS This observation included 98 high-risk cases of diabetic foot in our hospital during the period from August 2017 to October 2019, and these patients were randomly divided into the basic nursing group and the one-to-one education group with 49 patients per group. The basic nursing group only received routine basic nursing, while the one-to-one education group gave patients one-to-one education on the basis of basic nursing. After nursing, the self-care ability and compliance behavior of the two groups were evaluated and compared between these two groups. The knowledge mastery of the patient and the satisfaction of nursing were accounted.
RESULTS The assessment results of patients (self-care responsibility, self-care skills, self-concept and self-care knowledge) were significantly higher in the one-to-one education group than in the basic nursing group. The scores of compliance behaviors (foot bathing, shoes and socks selection, sports health care) in the one-to-one education group were significantly higher than those in the basic nursing group. Patients in the one-to-one education group had a significantly higher level of knowledge mastery and satisfaction of nursing than the basic nursing group.
CONCLUSION One-to-one education for high-risk cases of diabetic foot is helpful to improve the cognition and self-care ability of patients with diabetic foot, to ensure that patients follow the doctor’s advice of self-care and to improve their nursing satisfaction.
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Affiliation(s)
- Xia-Jun Fu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Shi-Di Hu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Yin-Fang Peng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Ling-Yan Zhou
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Ting Shu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
| | - Dan-Dan Song
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, Guangdong Province, China
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16
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Nickinson ATO, Dimitrova J, Houghton JSM, Rate L, Dubkova S, Lines H, Gray LJ, Nduwayo S, Payne TJ, Sayers RD, Davies RSM. Does the Introduction of a Vascular Limb Salvage Service Improve One Year Amputation Outcomes for Patients with Chronic Limb-Threatening Ischaemia? Eur J Vasc Endovasc Surg 2021; 61:612-619. [PMID: 33583708 DOI: 10.1016/j.ejvs.2020.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/21/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Vascular limb salvage services are recommended by the Global Vascular Guidelines to help improve outcomes for patients with chronic limb-threatening ischaemia (CLTI), although their description within the literature is limited. This study reports the 12 month outcomes for an outpatient based vascular limb salvage (VaLS) clinic. METHODS An analysis of a prospectively maintained database, involving all consecutive patients diagnosed with CLTI within the VaLS clinic from February 2018-February 2019, was undertaken. Data were compared with two comparator cohorts, identified from coding data: 1) patients managed prior to the clinic, between May 2017 and February 2018 (Pre-Clinic [PC]); and 2) patients managed outside of clinic, between February 2018 and February 2019 (Alternative Pathways [AP]). Freedom from major amputation at 12 months was the primary outcome. Kaplan-Meier plots and adjusted Cox's proportional hazard models (aHR) were used to compare outcomes. RESULTS Five hundred and sixty-six patients (VaLS 158, AP 173, PC 235) were included (median age 74 years). Patients managed within the VaLS cohort were statistically significantly more likely to be free from major amputation (90.5%) compared with both the AP (82.1%, aHR 0.52, 95% confidence interval [CI] 0.28 - 0.98, p = .041) and the PC (80.0%; aHR 0.50, 95% CI 0.28 - 0.91, p = .022) cohorts at 12 months, after adjustment for age, disease severity, and presence of diabetes. CONCLUSION This study supports the recommendations of the Global Vascular Guidelines that vascular limb salvage clinics may improve the rate of major amputation. Furthermore, the study provides a reproducible service model that delivers timely vascular assessment in an ambulatory setting. Further evaluation is required to assess longer term outcomes.
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Affiliation(s)
- Andrew T O Nickinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Jivka Dimitrova
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - John S M Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lauren Rate
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Svetlana Dubkova
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hannah Lines
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Nduwayo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tanya J Payne
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rob D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Robert S M Davies
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
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17
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Mullan L, Wynter K, Driscoll A, Rasmussen B. Barriers and enablers to providing preventative and early intervention diabetes-related foot care: a qualitative study of primary care healthcare professionals' perceptions. Aust J Prim Health 2021; 27:319-327. [PMID: 33857402 DOI: 10.1071/py20235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 01/12/2023]
Abstract
This study explored the perceived healthcare system and process barriers and enablers experienced by GPs and Credentialled Diabetes Educators (CDEs) in Australian primary care, in the delivery of preventative and early intervention foot care to people with diabetes. A qualitative design with inductive analysis approach was utilised and reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Semi-structured interviews were conducted with two GPs and 14 CDEs from rural, urban and metropolitan areas of Australia. Participants were from New South Wales, South Australia, Victoria, Western Australia, the Northern Territory and Queensland. Barriers to providing foot care constituted five broad themes: (1) lack of access to footcare specialists and services; (2) education and training insufficiencies; (3) human and physical resource limitations related to funding inadequacies; (4) poor care integration such as inadequate communication and feedback across services and disciplines, and ineffectual multidisciplinary care; and (5) deficient footcare processes and guidelines including ambiguous referral pathways. Enablers to foot care were found at opposing ends of the same spectra as the identified barriers or were related to engaging in mentorship programs and utilising standardised assessment tools. This is the first Australian study to obtain information from GPs and CDEs about the perceived barriers and enablers influencing preventative and early intervention diabetes-related foot care. Findings offer an opportunity for the development and translation of effective intervention strategies across health systems, policy, funding, curriculum and clinical practice, in order to improve outcomes for people with diabetes.
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Affiliation(s)
- Leanne Mullan
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Western Health Partnership, 176 Furlong Road, St Albans, Burwood, Vic. 3021, Australia
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Western Health Partnership, 176 Furlong Road, St Albans, Burwood, Vic. 3021, Australia; and Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, DK-5230 Odense M, Denmark
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18
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Nickinson ATO, Houghton JSM, Bridgwood B, Essop-Adam A, Nduwayo S, Payne T, Sayers RD, Davies RSM. The utilisation of vascular limb salvage services in the assessment and management of chronic limb-threatening ischaemia and diabetic foot ulceration: A systematic review. Diabetes Metab Res Rev 2020; 36:e3326. [PMID: 32314493 DOI: 10.1002/dmrr.3326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/08/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022]
Abstract
Specialist vascular limb salvage services have gained prominence as a new model of care to help overcome barriers which exist in the management of patients with chronic limb-threatening ischaemia (CLTI) and/or diabetic foot ulceration (DFU). This systematic review aims to explore the nature of reported services, investigate their outcome in the management of CLTI/DFU, and assess the scope and quality of the evidence base to help make recommendations for future practice and research. A systematic search of MEDLINE, Embase, The Cochrane Library, Scopus and CINAHL, from 1st January 1995 to 18th January 2019, was performed. Specialist vascular limb salvage services were defined as those services conforming to the definition of "centres of excellence" within the 2019 Global Vascular Guidelines. A study protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019123325). In total, 2260 articles were screened, with 12 articles (describing 11 services) included in a narrative synthesis. All services ran akin to the "toe-and-flow" model, with a number of services having additional core input from diabetology, microbiology, allied health professionals and/or internal/vascular medicine. Methodological weaknesses were identified within the design of the included articles and only one was deemed of high quality. The inception of services was associated with improved rates of major amputation; however, no significant changes in minor amputation or mortality rates were identified. Further research should adopt more a standardised study design and outcomes measures in order to improve the quality of evidence within the literature.
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Affiliation(s)
- A T O Nickinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - J S M Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - B Bridgwood
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - A Essop-Adam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - S Nduwayo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - T Payne
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - R D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - R S M Davies
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
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19
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Mullan L, Wynter K, Driscoll A, Rasmussen B. Prioritisation of diabetes-related footcare amongst primary care healthcare professionals. J Clin Nurs 2020; 29:4653-4673. [PMID: 32956503 DOI: 10.1111/jocn.15506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/09/2020] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES To assess primary healthcare professionals' priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care. BACKGROUND DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation. DESIGN A cross-sectional quantitative study reported according to STROBE statement. METHODS General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey. RESULTS On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20-year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n = 73) of participants and podiatry referrals a priority for 53% (n = 50) of participants only when a "foot concern" was raised. Referrals to specialist high-risk foot podiatrists or services were a first priority for 56% (n = 53), when the person had significant amputation risk factors. CONCLUSION Diabetes-related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD. RELEVANCE TO CLINICAL PRACTICE This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation.
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Affiliation(s)
- Leanne Mullan
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia.,Centre for Quality and Patient Safety, Deakin University, Geelong, Australia.,Western Health Partnership, St. Albans, Vic., Australia
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia.,Centre for Quality and Patient Safety, Deakin University, Geelong, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia.,Centre for Quality and Patient Safety, Deakin University, Geelong, Australia.,Western Health Partnership, St. Albans, Vic., Australia.,Faculty of Health and Medical Sciences, Copenhagen, Denmark.,Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Odense, Denmark
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20
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Missed Opportunities for Timely Recognition of Chronic Limb Threatening Ischaemia in Patients Undergoing a Major Amputation: A Population Based Cohort Study Using the UK's Clinical Practice Research Datalink. Eur J Vasc Endovasc Surg 2020; 60:703-710. [PMID: 32718828 DOI: 10.1016/j.ejvs.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 04/09/2020] [Accepted: 05/05/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Opportunities for timely recognition of chronic limb-threatening ischaemia (CLTI) within primary care, such as performing cardiovascular assessment during clinical consultation, are possibly being missed. This study aimed to investigate for potential "missed opportunities" within primary care. METHODS This was a population based cohort study, using the UK's Clinical Practice Research Datalink (CPRD). Patients undergoing a major amputation for CLTI between 1 January 2000 and 31 December 2016 were included. Primary care consultation and patient clinical data within the one year period prior to amputation were extracted from the CPRD. Dates of last primary care consultation and cardiovascular assessment prior to amputation were evaluated. Timings of latest cardiovascular assessments were stratified into "recent" (7-90 days before amputation) and "late" (> 91 days). RESULTS In total, 3 260 patients were included. In the year prior to amputation, patients attended a median of 19 (range 9-32) primary care consultations; however, prescription of secondary preventive medications was poor (antiplatelet 49.7%; lipid lowering agent 40.7%). Overall, 2 175 patients (66.7%) attended a primary care consultation 7-30 days before their amputation. However, only 416 (12.8%) underwent a cardiovascular assessment within this period, with 2 073 (63.6%) undergoing no assessment within 90 days of their amputation. Of these 2 073 patients, 1 230 (59.3%) had a primary care consultation 7-30 days before their procedure. Patients undergoing "late" assessment were younger (p = .003), with higher systolic (p = .008) and diastolic (p = .001) blood pressures than those undergoing "recent" assessment. Differences were also observed between assessment timings by deprivation (p = .003) and ethnicity (p = .006). CONCLUSION Missed opportunities for timely recognition potentially exist and may be related to age, deprivation, and ethnicity. Further work is required to investigate these factors, as well as individual amputations to identify the causes precipitating amputation. Greater emphasis on the medical management of peripheral arterial disease and identifying cardiovascular risk factors in patients who may not fit the "at risk" stereotype, are also required.
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21
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Das A, Pendsey S, Abhyankar M, Malabade R. Management of Diabetic Foot in an Indian Clinical Setup: An Opinion Survey. Cureus 2020; 12:e8636. [PMID: 32685305 PMCID: PMC7364422 DOI: 10.7759/cureus.8636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Objective The goal of this study was to evaluate foot-care practices by physicians throughout India who had participated in the Diabetic Foot Education Program (DFEP). Methods A structured questionnaire was administered to physicians throughout India, and their responses were analyzed descriptively. Results A total of 377 doctors responded to the DFEP opinion survey, including 261 doctors who belonged to independent diabetic foot clinics. Of these doctors, 44.4% reported managing fewer than five diabetic foot patients per week and 42.8% reported managing 5-10 patients per week. Most of these patients had non-ischemic foot, followed by those with ischemic and Charcot foot. About 58% of these physicians reported performing comprehensive clinical examinations and providing optimal preventive and therapeutic care in the treatment of diabetic foot, whereas only 25.7% reported performing only callus removal and changing dressings. Basic instruments to manage diabetic foot included the monofilament, tuning fork, biothesiometer, handheld Doppler, and pedometer, which were used by 76%, 75.5%, 59.5%, 27.7%, and 12.8% of doctors, respectively. The most common comorbidities were neuropathy, reported by 333 doctors, followed by peripheral vascular disease, reported by 297 doctors. Tools for diabetic foot education included posters in the clinic, used by 75% of doctors; pamphlets, used by 56.2%; videos, used by 45.2%; and diabetic foot applications, used by 36.7% of doctors. Conclusions There is a need to promote diabetic foot awareness and implement foot-care strategies to prevent diabetic foot and effectively manage this condition. Diabetic foot education programs will encourage clinicians to effectively use diagnostic tools for assessment and management of diabetic foot and to establish independent diabetic foot clinics.
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Affiliation(s)
- Ashok Das
- Medicine and Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | - Sharad Pendsey
- Diabetology, Step-by-Step Foot Care Project, Nagpur, IND
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Lasschuit J, Greenfield J, Tonks K. High Risk Foot Service reduces number of Emergency Department presentations and length of stay. DIABETES & METABOLISM 2020; 46:252-255. [DOI: 10.1016/j.diabet.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 06/29/2018] [Accepted: 07/07/2018] [Indexed: 11/26/2022]
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A systematic review investigating the identification, causes, and outcomes of delays in the management of chronic limb-threatening ischemia and diabetic foot ulceration. J Vasc Surg 2019; 71:669-681.e2. [PMID: 31676182 DOI: 10.1016/j.jvs.2019.08.229] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients presenting with chronic limb-threatening ischemia and diabetic foot ulceration (DFU) are at high risk of major lower limb amputation. Long-standing concern exists regarding late presentation and delayed management contributing to increased amputation rates. Despite multiple guidelines existing on the management of both conditions, there is currently no accepted time frame in which to enact specialist care and treatment. This systematic review aimed to investigate potential time delays in the identification, referral, and management of both chronic limb-threatening ischemia and DFU. METHODS A systematic review conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards was performed searching MEDLINE, Embase, The Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature from inception to November 14, 2018. All English-language qualitative and quantitative articles investigating or reporting the identification, causes, and outcomes of time delays within "high-income" countries (annual gross domestic product per person >$15,000) were included. Data were extracted independently by the investigators. Given the clinical crossover, both conditions were investigated together. A study protocol was designed and registered at the International Prospective Register of Systematic Reviews. RESULTS A total of 4780 articles were screened, of which 32 articles, involving 71,310 patients and 1388 health care professionals, were included. Twenty-three articles focused predominantly on DFU. Considerable heterogeneity was noted, and only 12 articles were deemed of high quality. Only four articles defined a delay, but this was not consistent between studies. Median times from symptom onset to specialist health care assessment ranged from 15 to 126 days, with subsequent median times from assessment to treatment ranging from 1 to 91 days. A number of patient and health care factors were consistently reported as potentially causative, including poor symptom recognition by the patient, inaccurate health care assessment, and difficulties in accessing specialist services. Twenty articles reported outcomes of delays, namely, rates of major amputation, ulcer healing, and all-cause mortality. Although results were heterogeneous, they allude to delays being associated with detrimental outcomes for patients. CONCLUSIONS Time delays exist in all aspects of the management pathway, which are in some cases considerable in length. The causes of these are complex but reflect poor patient health-seeking behaviors, inaccurate health care assessment, and barriers to referral and treatment within the care pathway. The adoption of standardized limits for referral and treatment times, exploration of missed opportunities for diagnosis, and investigation of novel strategies for providing specialist care are required to help reduce delays.
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Walker CA, Rahman A, Gipson-Jones TL, Harris CM. Hospitalists' Needs Assessment and Perceived Barriers in Wound Care Management: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2019; 46:98-105. [PMID: 30844867 DOI: 10.1097/won.0000000000000512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The purpose of this quality improvement project was to determine hospitalists' knowledge, practices, and perspectives related to management of pressure injuries and neuropathic/diabetic foot complications (having a foot ulcer or subsequent development of a foot infection because of a foot ulcer). We also sought to identify resources for and knowledge-based barriers to management of these wounds. This quality improvement effort targeted an interdisciplinary group of 55 hospitalists in internal medicine that consisted of 8 nurse practitioners, 10 physician assistants, and 38 physicians. The site of this initiative was the Johns Hopkins Bayview Medical Center, a 342-bed academic hospital located in the mid-Atlantic United States (Baltimore Maryland). The first phase of our quality improvement project comprised an online survey to identify hospitalists' knowledge, practices, and opinions on inpatient management of pressure injuries and diabetic foot complications. The second phase involved semistructured focus groups attended by hospitalists to identify resource gaps and barriers inferred by survey results. Twenty-nine of 55 (52%) hospitalists responded to the survey; 72% indicated no formal training in wound care. Over 90% had little to no confidence in management of pressure injuries and diabetic foot complications. In a separate ranking section of the survey, respondents selected lack of knowledge/confidence 12 of 29 (41.3%) and resources 9 of 29 (31.0%) as number 1 barriers to wound care. Managing patients with obesity was identified as a second major barrier from 10 of 29 selected options (34.5%). Eighteen of 55 (33%) hospitalists attended focus group sessions acknowledging barriers to wound care that included provider education, information technology, system factors, and interprofessional engagement. Attendees welcomed additional educational and ancillary resource support.
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Affiliation(s)
- Cynthia A Walker
- Cynthia A. Walker, MSN, RN, APRN-CNS, CWON, Interprofessional Practice & Patient Safety, Johns Hopkins Bayview Medical Center, Baltimore, Maryland. Alphonsa Rahman, DNP, APRN-CNS, CCRN, Interprofessional Practice & Patient Safety, Johns Hopkins Bayview Medical Center, Baltimore, Maryland. Trina L. Gipson-Jones, PhD, Hampton University, School of Nursing, Hampton, Virginia. Ché Matthew Harris, MD, MS, FACP, Department of General Internal Medicine, Johns Hopkins School of Medicine, Joint Appointment Johns Hopkins School of Nursing, Division of Hospital Medicine, Collaborative Inpatient Medicine Service, Baltimore, Maryland
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Guidelines for Diabetic Foot Care: A Template for the Care of All Feet. J Wound Ostomy Continence Nurs 2019; 46:241-245. [PMID: 31083067 DOI: 10.1097/won.0000000000000532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li J, Gu L, Guo Y. An educational intervention on foot self-care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers. J Clin Nurs 2019; 28:2506-2516. [PMID: 30697849 DOI: 10.1111/jocn.14810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 01/14/2023]
Abstract
AIMS AND OBJECTIVES To assess the effectiveness of a 12-week educational intervention on foot self-care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers in China. BACKGROUND Diabetes with the coexistence of diabetic retinopathy and foot problems complicating diabetes not only represents a personal disaster, but also becomes a serious burden to public health in China. A foot self-care educational intervention is both cost-effective and feasible even in a health resource-limited setting, which should be developed and evaluated. DESIGN Quasi-experimental. METHODS From July-September 2017, we enrolled 80 eligible hospitalised diabetic retinopathy patients and their primary caregivers by convenient sampling method in a first-class comprehensive hospital in Nantong, in China. Before and after the educational intervention that is in accordance with the TREND statement (for details, see the "Supplementary File 1"), researchers and subjects filled out the self-designed questionnaire on foot problems complicating diabetes and the Diabetic Foot Self-care Behavior Scale, respectively. RESULTS Scores of foot self-care behaviour among the subjects significantly improved from 54.19 ± 8.01-75.85 ± 5.04. The number of patients with fasting blood glucoses <7.0 mmol/L improved from 43 (53.75%)-80 (100%). The results of incidence of foot problems complicating diabetes were not statistically significant. The complete execution of each item in Diabetic Foot Self-care Behavior Scale of subjects was apparently higher. CONCLUSIONS This educational intervention can facilitate positive foot self-care behaviours among the diabetic retinopathy patients with visual disability and their primary caregivers in China. RELEVANCE TO CLINICAL PRACTICE This study adds to the evidence of the effectiveness of an educational intervention to foster positive foot self-care behaviours. This educational intervention appears to be prospective in promoting diabetic home-based self-management in China, and the delivery method of the intervention may be applied to other chronic diseases.
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Affiliation(s)
- Jiayu Li
- School of Nursing, Nantong University, Nantong, China
| | - Lipei Gu
- School of Nursing, Nantong University, Nantong, China
| | - Yujie Guo
- School of Nursing, Nantong University, Nantong, China
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Mullan L, Driscoll A, Wynter K, Rasmussen B. Barriers and enablers to delivering preventative and early intervention footcare to people with diabetes: a scoping review of healthcare professionals' perceptions. Aust J Prim Health 2019; 25:517-525. [DOI: 10.1071/py19115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study is to examine barriers and enablers to delivering preventative and early intervention footcare to people with diabetes, from the perspective of healthcare professionals within primary care. MEDLINE, CINAHL and Scopus databases, as well as Google Scholar, were searched in September 2018. Inclusion criteria included: English language, qualitative and quantitative studies, since 1998, reporting on barriers or enablers, as reported by primary care health professionals, to delivering preventative or early intervention footcare to people with diabetes. In total, 339 studies were screened. Eight studies met criteria. Perceived barriers to providing footcare included: geographical, administrative and communication factors; referral and care guideline availability and implementation challenges; limited availability of specialists and high-risk foot services; and limited resources including time and funding. Enablers to footcare were: implementation of footcare programs; education; clear definition of staff roles; development of foot assessment reminder systems; and reminders for people with diabetes to remove their shoes at appointments. Barriers and enablers to footcare are multifaceted. Healthcare professionals are affected by health system and individual factors. By implementing strategies to address barriers to footcare delivery, it is possible to improve outcomes for people with diabetes, thus reducing the effect of diabetes-related foot disease.
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