Management of peripheral arterial disease in diabetes: a national survey of podiatry practice in the United Kingdom

Pasha Normahani,Martin Fox,Nigel J Standfield,Chira Mustafa,Claire Duguid,Usman Jaffer

doi:10.1186/s13047-018-0270-5

Abstract

BackgroundWe aimed to investigate podiatry practice in diagnosing peripheral arterial disease (PAD) in diabetes, decision making once PAD is suspected and limitations of referral pathways.MethodsA survey, comprising 26 questions was distributed to podiatrists across the UK via mailing lists of collaborating organizations including the College of Podiatry (UK). Response rates were estimated based on NHS workforce data. Analysis of responses from the open-ended questions was performed using inductive content analysis.ResultsData from 283 respondents were analyzed. Response rate for all NHS podiatrists across the UK was estimated to be 6%. For the detection of arterial disease only 18.8% (n = 49/260) of participants reported using a full combination of history, pulse palpation, Doppler and ABPI assessment. Self-reported confidence in detecting arterial disease was highest amongst podiatrists who felt they had received adequate training compared to podiatrists who felt they had not (median 85 (IQR 75–90) vs 67 (50–77), respectively; p < 0.001) as well as those who see > 20 diabetic patients per week compared to those who see < 20 (median 80 (IQR 70–90) vs 72 (60–82.8), respectively; p < 0.001). Over one third of respondents (35.8%, n = 93/260) were aware of missed cases of PAD in the past year and 17.5% (n = 38/217) believed that this resulted in an amputation in some cases.The survey highlighted a lack of clarity amongst podiatrists regarding referral guidelines. Additionally, 69% (n = 169/242) reported that their patients had to wait longer than 2-weeks for specialist vascular assessment and 67.6% (n = 54/80) reported similar waits for a Duplex Ultrasound scan. There was a statistically significant variation in DUS waiting time across the UK (X2 (10, N = 80) = 21.59, p = 0.017). Inability to make a direct referral to vascular services and long delays were reported as major limitations of the referral pathway.ConclusionWe have identified important targets for further investigation and quality improvement.

Highlights

We aimed to investigate podiatry practice in diagnosing peripheral arterial disease (PAD) in diabetes, decision making once PAD is suspected and limitations of referral pathways
Regular assessment of vascular status by the Foot Protection Team (FPT) is of utmost importance in the management of the diabetic foot to detect the presence of peripheral arterial disease (PAD)
Current national data sets from England, provide very little information regarding practice patterns in PAD diagnosis, decision making once PAD is suspected and the status of vascular surgery referral pathways [13]. In this national survey of podiatry practice in the United Kingdom (UK), we aimed to investigate current practice in diagnosing PAD in diabetes, decision making once PAD is suspected and limitations of referral pathways

Summary

Introduction

We aimed to investigate podiatry practice in diagnosing peripheral arterial disease (PAD) in diabetes, decision making once PAD is suspected and limitations of referral pathways. Prevention and management of diabetic foot ulceration requires complex, well-coordinated multidisciplinary care across all healthcare settings as recommended by the National Institute of Health and Care Excellence (NICE) and the ‘Putting Feet First’ National Framework [1, 2]. This care pathway is structured to include a ‘Foot Protection Team (FPT)’ to work in the community, Regular assessment of vascular status by the FPT is of utmost importance in the management of the diabetic foot to detect the presence of peripheral arterial disease (PAD). Reported delays to vascular assessment and intervention in the literature negatively affect patient outcomes [11, 12]

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