Preventative and early intervention diabetes-related foot care practices in primary care

Abstract

The aim of this study was to identify current preventative and early intervention diabetes-related foot care practices among Australian primary care healthcare professionals. A survey was developed to obtain information about preventative and early intervention foot care actions, priorities of care, access and referral to expert multidisciplinary foot care teams and adherence to best-practice diabetes-related foot care recommendations. The survey was distributed to GPs and Credentialled Diabetes Educators (CDEs). Surveys were completed by 10 GPs and 84 CDEs. Only 45% of all respondents reported removing the shoes and socks of their patients with diabetes at a consultation. Eighty-one percent of participants reported having access to specialist multidisciplinary foot care teams. Those in urban settings were significantly more likely to report access than those in rural areas (P=0.04). Median scores indicated that participants did not often utilise specialist teams to refer patients with diabetes-related foot ulceration and Charcot’s neuroarthropathy. Only 16% of participants reported having access to specialist foot care telehealth services; patients with diabetes-related foot ulceration and Charcot’s neuroarthropathy were rarely referred to these services. This study is the first Australian study to elicit information about preventative and early intervention diabetes-related foot care practices by GPs and CDEs working in Australian primary care. In the presence of acute diabetes-related foot complications, primary healthcare practitioners are not always adhering to best practice foot care recommendations. Further studies are required to understand the reasons for this and ensure evidence-based best practice foot care delivery to people with diabetes.

Prioritisation of diabetes‐related footcare amongst primary care healthcare professionals

“…Fortunately, within Australia, a strong system of universal healthcare provides early access to medical treatment, subsidised medications and affordable referral to allied health professionals. However, even amongst healthcare professionals with extensive experience in diabetes care, delivery of best practice diabetes‐related footcare in primary care is inconsistent (Mullan et al., 2020). Barriers to footcare have been identified to be multifaceted, including geographical, administrative and communication limitations, referral and care guideline unavailability and implementation challenges, and limited human, service, equipment and funding resources (Mullan et al., 2019).…”

“…Varying rates of foot screening have been reported in primary care (Davies, 2014). A study of 94 primary care clinicians found that just 45% of participants remove the shoes and socks of their patients with diabetes at a consultation (Mullan et al., 2020). Another study involving 46 primary care nurses identified that 100% had not received education on diabetes‐related foot assessments in their nursing training and 80% were not confident in conducting such assessments (Lakha & Lee, 2018).…”

The High Re-Ulceration Rate in Lower Extremity Amputation Intervention in Type 2 Diabetic Vietnamese Patients After 24-Month Follow-Up at Cho Ray Hospital, Vietnam

“…Previous studies reported risk factors associated with reulceration including s poor glycemic control, 20 peripheral neuropathy, lower extremity artery disease, late foot ulcer diagnosis, non-adherence to appropriate footwear, and improper foot care. 16,17 In our study, the re-ulceration group had a long time of having diabetes as well as high failure rate in controlling HbA1c, so there could be more chronic complications (higher rate of monofilament loss of sensation and vascular stenosis) than in the non-re-ulcerative group. However, the duration of diabetes in foot ulcer patients in our study was shorter than in European and American studies.…”

“…T2DPs admitted late and receiving treatment at provincial hospitals may still be at risk of poor treatment outcomes due to primary care practitioners not adhering to best practice foot care recommendations. 16 T2DPs initially sought care from a variety of different venues—primary care doctors, podiatrists, specialists, emergency rooms, and urgent care clinics—as determined by how serious their DFU and insurance status and access issues. 17 Strategies to improve early detection and treatment of diabetic foot ulceration include patient education, regular foot exams, and multidisciplinary care teams.…”

Assessment, management and prevention of chronic wounds in the Australian context: a scoping review

“…Studies on offloading reported no benefit from silicone gel sheeting to prevent ulcer recurrence 94 , and significant differences in plantar pressures between a specialised shoe compared to canvas or participants' own shoes 52 . One study found only 45% of health professionals reported removing shoes and socks of their patients for foot assessment 95 , and two protocols were registered on preventive interventions 96,97 .…”