MEDICAL-SOCIAL AND ECONOMIC ISSUES IN TREATMENT OF PATIENTS WITH DIABETIC FOOT SYNDROME

Abstract

Introduction. Аt the present stage of treatment of patients with diabetic foot syndrome can not yet be considered satisfactory, which requires further study of this problem in order to improve the provision of medical and social care to the above patients. Aim. Тo study medical, social and economic issues of providing medical care to patients with diabetic foot syndrome based on the analysis of their treatment in the Ternopil region. Matherials and Methods. The study is based on a retrospective analysis of the treatment of 1963 patients with diabetes mellitus complicated by diabetic foot syndrome during 2000–2017. Neuropathic-infected form of foot lesion was diagnosed in 692 (35.2 %) patients, ischemic-gangrenous - in 604 (30.8 %), mixed – in 667 (34 %) patients. According to the degree of lesion (according to Megitt - Wagner), the distribution of patients was as follows: II – 247 (12.6 %) patients, III – 995 (50.7 %), IV – 584 (29.7 %), V – 137 7 %) of patients. Patients with acute purulent-necrotic lesions and chronic wound defects of the lower extremities underwent surgery of various volumes: surgical debridement, small or high amputation. Results. The analysis of the obtained results allowed to note a number of social, medical and economic problems, the solution of which will significantly improve the results of treatment and in particular reduce the number of amputations in patients with diabetic foot syndrome. As the analysis shows, typical mistakes in the treatment of patients can be divided into three main groups: organizational, diagnostic and tactical. Organizational mistake lies in the fact that today in Ukraine there is no single system providing skilled care to patients with diabetic foot syndrome. The most common diagnostic mistakes include incorrect and insufficiently qualified diagnostics of clinical forms of diabetic foot syndrome and the depths of the spread of purulent-necrotic lesions of the tissues of the foot. The above mistakes significantly affected the timing and results of treatment, worsening the results of the latter. Conclusions. Based on the analysis of treatment of 1963 patients with various pathogenetic forms of the diabetic foot syndrome, a number of medical, economic and social issues have been identified that require their solution. The most typical mistakes and shortcomings in the treatment of these patients were analyzed. A program was proposed to improve the quality of specialized medical care for patients with diabetic foot syndrome.