International collaboration in Guyana to reduce amputations in persons with diabetes

Abstract

aim: This project created an interprofessional, patient-centered clinic in Guyana, South America to prevent and treat diabetic foot ulcers and reduce amputations. Methods: A multi-faceted, longitudinal, evidence-informed educational intervention, was linked to professional practice change and improved patient outcomes. The educational program was designed to: a apply effective primary and secondary educational strategies to translate knowledge into practice, b adapt the highly rated evidence-based guidelines from the Registered Nurses Association of Ontario and the Best Practice recommendations of the Canadian Association of Wound Care in a resource-poor setting, and c identify and empower key opinion leaders with a collaborative practice model. results: The interprofessional Diabetic Foot Centre was opened at the Georgetown Public Hospital Corporation in July 2008. Four teams of doctors, nurses and rehabilitation specialists were trained and mentored by an expert Canadian team modeling interprofessional collaboration. Thirty participants were taught in two training visits (20 trainees attended both). Trainees rotated through the clinic working with context-specific enablers that acted as quick reference guides to translate new knowledge into practice. The new knowledge was reinforced with practice reflection through daily seminars. To empower four key opinion leaders with a greater theoretical framework for education methodology, wound care practices and health care systems, they and the project coordinator were enrolled in the International Interprofessional Wound Care Course from the University of Toronto. This course consists of two 4 day residential weekends of interprofessional education separated by 8 months of self study modules and a selective that relates course material to day to day practice. Discussion/conclusions: Diabetic foot ulcers are a major and growing public health problem in Guyana and elsewhere. They represent the single largest (30%) reason for admission to the surgical wards. The development of sustainable local capacity in low-income countries requires more than one time training sessions. This international collaboration developed local capacity by modeling and adapting Best Practices using primary and secondary (enabling and reinforcing) educational strategies in a longitudinal format with key opinion leader training. This multiple intervention model has facilitated interprofessional collaboration along with knowledge, skills and attitude change to improve diabetic foot care patient outcomes.