Prioritisation of diabetes‐related footcare amongst primary care healthcare professionals

Abstract

Aims and objectives: To assess primary healthcare professionals' priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care. Background: DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation. Design: A cross-sectional quantitative study reported according to STROBE statement. Methods: General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey. Results: On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20-year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n = 73) of participants and podiatry referrals a priority for 53% (n = 50) of participants only when a "foot concern" was raised. Referrals to specialist high-risk foot podiatrists or services were a first priority for 56% (n = 53), when the person had significant amputation risk factors. Conclusion: Diabetes-related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD. Relevance to clinical practice: This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation.

Foot Care Prioritization Among Health Care Providers Treating Diabetic Patients in Saudi Arabia: A Survey-Based Study

“…These results emphasize the importance for clinicians to prioritize preventative foot care at an earlier stage in the diabetes care continuum. Additionally, the findings underscore the significance of proactive foot care practices over reactive ones, as such prioritization is crucial in preventing foot ulcers and the subsequent need for amputation [ 16 ]. Furthermore, binary logistic regression analysis revealed that healthcare professionals within the age range of 35-44 years, with 5-10 years of experience, employed at private hospitals, managing a higher number of practice clinics per week, and treating a greater number of patients with diabetes in each clinic, exhibited a greater likelihood of prioritizing foot care in their clinical practices.…”

“…This study used an online survey that Mullan et al [ 16 ] had previously validated in a cross-sectional study they conducted in Australia. The questionnaire was constructed on Google Form® and then distributed via online platforms to the targeted population of the study (inclusion criteria below) using a convenience sampling technique.…”

“…Furthermore, it was found that referrals to high-risk specialist foot podiatrists or services were prioritized for only 56% of participants in cases where significant amputation risk indicators were present. This study emphasizes the importance of primary healthcare professionals giving more priority to preventative foot care throughout the early stages of diabetes management in order to mitigate the occurrence of foot ulcers and amputations [ 16 ]. Therefore, the aim of our research is to evaluate the degree of importance given to foot care by healthcare professionals who are responsible for treating individuals with diabetes in Riyadh, Saudi Arabia.…”

What is the Lived Experience of the ‘Three Great Pathologies’ of Diabetic Foot Disease? An Interpretative Phenomenological Analysis of the Independent Thinking of Podiatrists in Diabetes Secondary Care

“…This is a centralised model of care, as the MDT provides integrated diabetes care in one place. 90 This is considered to be the gold standard of care due to the complex needs of patients with DFD and in terms of how podiatry services are delivered 91,92 as it is seen as the most effective method of delivering podiatry care in diabetes care settings. 93 ‘Where we work here we have team of clinicians, we had this team before we had our actual more targeted multidisciplinary team.’ (Betsy) ‘I am really lucky to be a part of an awesome interdisciplinary team.’ (Aroha) ‘I feel lucky that we’re in a multidisciplinary setting because if you’re in isolation you’d be very limited in what you could do.’ (Drew) ‘Also, the diabetes team we do work with.…”

“…This is a centralised model of care, as the MDT provides integrated diabetes care in one place. 90 This is considered to be the gold standard of care due to the complex needs of patients with DFD and in terms of how podiatry services are delivered 91,92 as it is seen as the most effective method of delivering podiatry care in diabetes care settings. 93 'Where we work here we have team of clinicians, we had this team before we had our actual more targeted multidisciplinary team.'…”