Abstract
BackgroundNeuropathy and vasculopathy can lead to costly and debilitating complications in people with diabetes. The purpose of this study was to evaluate, at an organizational level, uptake of practices included in a diabetic foot care clinical pathway and associated resources. This research focused on patients at low and moderate risk in Alberta, Canada between 2014 to 2019.MethodsSerial surveys (2014, 2019) of practices related to screening and care of the feet of people with diabetes. Surveys were administered using a combination of targeted and snowball sampling in order to assess the impact of the clinical pathway first implemented in 2015. The pathway focused on screening, assessment and referral of patients from primary care. High-risk foot teams (HRFT) were established at six sites to provide increased access to specialty care. Comparative statistics were performed to assess differences in footcare practices between 2014 and 2019 using two-tailed Fisher’s exact test or Chi-square test.ResultsRespondents (n = 104, 2014 and n = 75, 2019) included personnel from primary health care, home care and long-term care, acute and emergency care, specialty clinics, diabetes-specific programs and private contractors. The proportion of primary care and home care/long-term care (HC/LTC) sites providing screening increased significantly (p < 0.05). A significant increase in the proportion of sites providing assessment for patients designated as moderate risk also increased from 35% (34 out of 96 sites) to 55% (36 out of 65 sites) (p < 0.05), particularly with respect to vascular assessment, and the proportion of sites reporting appropriate follow-up intervals according to the pathway recommendation was also improved.ConclusionProvision of a clinical pathway for diabetic foot care along with education and resources led to increased screening in primary care and HC/LTC settings in Alberta, Canada. HRFT provided primary healthcare providers with an important option for referral and also provided increased expertise for procedures such as vascular assessment for patients with moderate risk of ulceration. This comprehensive model has the potential to reduce progression of foot problems and overall health services utilization. Further analyses of outcomes such as incident lower limb amputation and long-term cost-effectiveness of pathway implementation are underway.
Highlights
Provision of a clinical pathway for diabetic foot care along with education and resources led to increased screening in primary care and home care/long-term care (HC/LTC) settings in Alberta, Canada
Diabetic foot ulcer (DFU) is a severe diabetes complication often leading to lower limb amputations
DFU and lower limb amputations in people with diabetes are potentially preventable in 75% [3] and 50–85% of cases, respectively, through screening, early treatment and better self-care practices [4]
Summary
Diabetic foot ulcer (DFU) is a severe diabetes complication often leading to lower limb amputations. DFU and lower limb amputations in people with diabetes are potentially preventable in 75% [3] and 50–85% of cases, respectively, through screening, early treatment and better self-care practices [4]. Patient education is recommended as important to reduce risk of diabetic foot complications [7]. Efforts to prevent DFU in patients identified at moderate to high risk, have a strong possibility of cost-effectiveness [8] probably through reduction of emergency department or inpatient admissions, which are increased by 3-fold in patients with DFU compared with other ambulatory clinic cases [9]. This research focused on patients at low and moderate risk in Alberta, Canada between 2014 to 2019
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