<p>Multidisciplinary Management of Diabetic Foot Ulcers in Primary Cares in Quebec: Can We Do Better?</p>

Abstract

A growing body of evidence supports the presence of integrated foot care based on multidisciplinary and interdisciplinary teams in the management and prevention of diabetic foot ulcer (DFU) worldwide. This model of care is however rare in the clinical setting in Quebec, Canada. Many best practice gaps are identified as well as probable causal hypothesis are listed in this commentary. We support our opinions with a pilot audit conducted as part of a continuous quality improvement process in managing patients with DFU in our area and on Canadian facts and data. Our pilot study (n = 27 hospitalized patients) included a typical DFU population with neuropathy, peripheral arterial disease and previous amputation. It highlights underachievement of best practice recommendations implementation such as multidisciplinary DFU management and offloading interventions in our establishment. Due the high morbidity and mortality associated with DFU patients, four died during the studied hospitalization episode. Several barriers were encountered in the pilot audit justifying that no robust conclusion can be raised. However, our observations are concerning. Even though data accessibility was limited, our observations are sadly coherent with what is found in the literature. Economic data of what this means for our health system is put forward in the overall discussion. We are preoccupied by the trends outlined by some facts and observations, and this commentary was written with this in mind. In the face of the diabetes crisis that is arising, a plea is made to reassess care pathway for this vulnerable population as we emphasize the importance of teamwork in managing DFU.

A novel Canadian multidisciplinary acute care pathway for people hospitalised with a diabetic foot ulcer

“…Nather and colleagues reported a reduction in the hospitalisation cost per patient after the formation of a multidisciplinary team but was not statistically significant 21 . Recent Canadian studies discussed the multidisciplinary team approach for DFU patients and advocated for intensive inpatient and outpatient management, and follow‐up care 16,17,26‐31 . However, no Canadian study has described the implementation of a team‐based acute care DFU pathway.…”

“…21 Recent Canadian studies discussed the multidisciplinary team approach for DFU patients and advocated for intensive inpatient and outpatient management, and follow-up care. 16,17,[26][27][28][29][30][31] However, no Canadian study has described the implementation of a team-based acute care DFU pathway.…”

Diabetic foot ulcers: treatment overview and cost considerations

“…70,71 A DFU is a complex multisystem hard-to-heal wound, therefore, it requires a complex multidisciplinary approach. 72 A systematic review by Musuuza et al, 73 has shown that multiple single-centre studies have reported significant reductions in major amputations among patients with DFUs after initiation of multidisciplinary teams. After carefully analsysing results, while multidisciplinary team composition was variable, their involvement reduced major amputations in 94% of the studies reviewed.…”

Burden of diabetic foot syndrome in rural community: Need for screening and health promotion

“…At the primary care level, there is need for screening tests to identify at risk foot at an early stage, pressure relief, care of the wound and appropriate referral. [ 5 ] Although the burden of diabetes is known to be very high in Kerala, there is scare evidence on DFS. Therefore, this study aimed at examining DFS and the associated factors at community level.…”