Delay in the referral trajectory of patients with diabetic foot ulcers

NewsBot · Oct 23, 2013

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Patient and professional delay in the referral trajectory of patients with diabetic foot ulcers.
Sanders AP, Stoeldraaijers LG, Pero MW, Hermkes PJ, Carolina RC, Elders PJ.
Diabetes Res Clin Pract. 2013 Oct 1.

AIMS:
A cohort study investigated referral and treatment trajectories of patients with diabetic foot ulceration consulting podiatrists. The study aims were to quantify patient, professional and treatment (=total) delay and to identify relationships between patient- or professional-related characteristics, delays or ulcer healing time.
METHODS:
Ten podiatrists specialising in diabetes care included 54 consecutive adults with diabetic foot ulceration. Assessments were performed retrospectively (e.g. delays) and prospectively (12 weeks).
RESULTS:
Median (SD; range) patient delay was 3.0 days (50.6; 0-243), professional delay 7.0 days (63.4; 0-279) and treatment delay 20.5 days (97.3; 0-522). 57% of patients took >2 weeks before visiting a podiatrist. Ulcers healed in 67% of patients in 49.0 days (90.2; 4-408). The number of health care professionals in the referral trajectory was positively related to treatment delay (p<0.01) and to ulcer healing time (p<0.01). Professional delay and treatment delay was positively correlated with the duration of the podiatric treatment (p<0.05). Patient awareness of ulceration risk tended to decrease the healing time.
CONCLUSIONS:
Patients with diabetic foot ulcers presented small median delays in the referral trajectory to podiatrists specialising in diabetes. The study results suggest that reducing the number of health care professionals in the referral trajectory might decrease treatment delay and ulcer healing time. Also improving patient awareness of ulceration risk might be beneficial for the healing time.
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Admin2 · Oct 23, 2013

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NewsBot · Dec 5, 2014

Adverse events in diabetic foot infections: a case control study comparing early versus delayed medical treatment after home remedies.
Cawich SO, Harnarayan P, Islam S, Budhooram S, Ramsewak S, Naraynsingh V.
Risk Manag Healthc Policy. 2014 Nov 27;7:239-243. eCollection 2014.

BACKGROUND:
The aim of conventional medical therapy in diabetic foot infections is to control infection, thereby reducing amputation rates, infectious morbidity, and death. Any delay incurred during a trial of home remedies could allow an infection to progress unchecked, increasing the risk of these adverse outcomes. This study sought to determine the effects of delayed operative interventions and amputations in these patients.
METHODS:
A questionnaire study targeting all consecutive patients admitted with diabetic foot infection was carried out over 1 year. Two groups were defined, ie, a medical therapy group comprising patients who sought medical attention after detecting their infection and a home remedy group comprising those who voluntarily chose to delay medical therapy in favor of home remedies. The patients were followed throughout their hospital admissions. We recorded the duration of hospitalization and number of operative debridements and amputations performed.
RESULTS:
There were 695 patients with diabetic foot infections, comprising 382 in the medical therapy group and 313 in the home remedy group. Many were previously hospitalized for foot infections in the medical therapy (78%) and home remedy (74.8%) groups. The trial of home remedies lasted for a mean duration of 8.9 days. The home remedy group had a longer duration of hospitalization (16.3 versus 8.5 days; P<0.001), more operative debridements (99.7% versus 94.5%; P<0.001), and more debridements per patient (2.85 versus 2.45; P<0.001). Additionally, in the home remedy group, there was an estimated increase in expenditure of US $10,821.72 US per patient and a trend toward more major amputations (9.3% versus 5.2%; P=0.073).
CONCLUSION:
There are negative outcomes when patients delay conventional medical therapy in favour of home remedies to treat diabetic foot infections. These treatments need not be mutually exclusive. We encourage persons with diabetes who wish to try home remedies to seek medical advice in addition as a part of holistic care.
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NewsBot · Oct 21, 2018

Therapeutic Itinerary and Causes of Delay in Specialized Consultation of Patients Admitted for Diabetic Foot
Jules Gninkoun et al
JDM> Vol.8 No.4, November 2018

Introduction: Amputation remains a common practice in patients admitted for diabetic foot. The delay in consultation is one of the main reasons. The objective of this work was to analyze patients’ itinerary care and to identify the causes of delay in consultation in patients admitted for diabetic foot. Method: This is a descriptive cross-sectional study, including all patients hospitalized for diabetic foot. A wait of at least seven (7) days before consulting the Endocrinology department of Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) after the foot injury occurred was considered as delay in consultation. The data were recorded and analyzed in the EPI INFO software. The description of the sample was made according to the usual statistics (frequency, average, standard deviation). Results: Seventy-six (76) diabetic foot cases were admitted during the period of the study. The mean age of the patients was 56.64 ± 10.71 years with extremes of 29 years and 84 years. Patients were most often received at an advanced stage of the foot injury, 3D stage of Texas classification in 87% of cases and Wagner grades 4 and 5 in 52% of cases. The amputation rate was 38.16%. An analysis of the first care places reveals that 90.8% of patients had consulted conventional medicine, 13.2% in traditional medicine; 1.2% had religious practices and 18.7% had declared self-medication at home. Consultation period at CNHU HKM was more than 7 days in 80% of cases and less than 7 days in 20% of cases. The average consultation time was 44.08 ± 26.43 days with extremes of 1 and 480 days. The main reasons for the delay in seeking hospital care cited by diabetic patients were fear of amputation (47.8% of cases), economic difficulties (32.5% of cases) and awareness lack of the situation seriousness (22.4%). Conclusion: The therapeutic itinerary of patients with diabetic foot was particularly long. The main reasons of late appeal to specialized care were fear of amputation and economic difficulties. The implementation of universal health insurance and an information, education and communication program could certainly reduce the periods allowed for recourse to care and therefore to reduce the amputation rate.
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NewsBot · Aug 10, 2019

Referral of patients with diabetic foot ulcers in four European countries: patient follow-up after first GP visit.
Sánchez-Ríos JP et al
J Wound Care. 2019 Aug 1;28(Sup8):S4-S14

OBJECTIVE:
This study aimed to analyse the characteristics of patients, including demographics, medical history and treatment, with a diabetic foot ulcer (DFU) during their first follow-up visit to a general practitioner (GP).

METHODS:
A two-part quantitative online questionnaire was distributed among GPs in France, UK, Germany and Spain. Part one entailed a survey of GPs' perceptions of referrals for DFU. Part two collected data on recently managed DFU cases. The percentage of responses was compared for each question and across the four countries for significant differences.

RESULTS:
In part one of the study, 600 questionnaires were collected (150 per country) and 1188 patients managed for a DFU were included in the second part. About 88% of patients had type 2 diabetes, with a significant proportion of suboptimal control (average HbA1c: 10.64mmol/l). A patient complaint led to diagnosis in 60% of the cases. Wounds were found to be more frequently located in the toes and midfoot, and were superficial (according to the Texas Wound Classification system) in 80% of the cases. More than two-thirds of patients developed small wounds (<5cm2); more than half of them had infected wounds. Approximately 50% of wounds were ischaemic, which triggered the onset of a DFU. Follow-up wound examinations before and after hospitalisation were performed by nurses, except in Germany where GPs undertook this role, including prescribing offloading devices and in the UK where follow-up was managed by podiatrists. Ischaemia, wound necrosis, suspected osteomyelitis and absence of wound healing were the primary reasons for hospital admission during the first month after diagnosis.

CONCLUSION:
Delay in specialised foot care is a recurring topic in the treatment of DFUs, even with different health-care structures across Europe. Knowledge and education on DFUs should be reinforced among GPs and nurses to establish a global DFU care network between primary and specialised care, avoid hospitalisation and adequately manage high-risk patients.
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NewsBot · Aug 18, 2019

A systematic review investigating the identification, causes and outcomes of delays in the management of chronic limb threatening ischaemia and diabetic foot ulceration
Nickinson, A et al
Journal of Vascular Surgery, 2019, In Press

Objectives
Patients presenting with chronic limb threatening ischaemia (CLTI) and diabetic foot
ulceration (DFU) are at high risk of major lower limb amputation. Long-standing concern
exists regarding late presentation and delayed management contributing to increased
amputation rates. Despite multiple guidelines existing on the management of both conditions,
there is currently no accepted timeframe in which to enact specialist care and treatment. This
systematic review aims to investigate potential time delays in the identification, referral and
management of both CLTI and DFU.
Methodology
A systematic review, conforming to the Preferred Reporting Items for Systematic Review of
Meta-Analysis (PRISMA) statement standards, was performed searching MEDLINE, Embase,
The Cochrane Library and CINAHL from inception to 14 13 th November 2018. All English
language qualitative and quantitative articles investigating or reporting the identification,
causes and outcomes of time delays within ‘high income’ countries (annual gross domestic
product per person >$15,000) were included. Data were extracted independently by the
investigators. Given the clinical cross-over, both conditions were investigated together. A study
protocol was designed and registered at the International Prospective Register of Systematic
Reviews (PROSPERO) (registration number: CRD42018115286).
Results
A total of 4780 articles were screened, of which 32 articles, involving 71,310 patients and
1,388 healthcare professionals were included. Twenty-three articles focussed predominantly
on DFU. Considerable heterogeneity was noted and only 12 articles were deemed of high
quality. Only 4 articles defined a ‘delay’ however this was not consistent between studies.
Median times from symptom onset to specialist healthcare assessment ranged from 15 to 126
days with subsequent median times from assessment to treatment ranging from 1 to 91 days.
A number of patient and healthcare factors were consistently reported as potentially causative
including, poor patient symptom recognition, inaccurate healthcare assessment and difficulties
in accessing specialist services. Twenty articles reported outcomes of delays, namely rates of
major amputation, ulcer healing and all-cause mortality. Although results were heterogeneous,
they elude to delays being associated with detrimental outcomes for patients.
Conclusions
Time delays exist in all aspects of the management pathway, which are in some cases
considerable in length. The causes of these are complex but reflect poor patient health-seeking
behaviours, inaccurate healthcare assessment and barriers to referral and treatment within the
care pathway. The adoption of standardised limits for referral and treatment times, exploration
of missed opportunities for diagnosis and investigation of novel strategies for providing
specialist care are required to help reduce delays.
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NewsBot · Jun 9, 2020

Expect delays: poor connections between rural and urban health systems challenge multidisciplinary care for rural Americans with diabetic foot ulcers
Bryn L. Sutherland, Kristen Pecanac, Christie M. Bartels & Meghan B. Brennan
Journal of Foot and Ankle Research volume 13, Article number: 32 (2020)

Background
Rural Americans with diabetic foot ulcers (DFUs) face a 50% increased risk of major amputation compared to their urban counterparts. We sought to identify health system barriers contributing to this disparity.

Methods
We interviewed 44 participants involved in the care of rural patients with DFUs: 6 rural primary care providers (PCPs), 12 rural specialists, 12 urban specialists, 9 support staff, and 5 patients/caregivers. Directed content analysis was performed guided by a conceptual model describing how PCPs and specialists collaborate to care for shared patients.

Results
Rural PCPs reported lack of training in wound care and quickly referred patients with DFUs to local podiatrists or wound care providers. Timely referrals to, and subsequent collaborations with, rural specialists were facilitated by professional connections. However, these connections often were lacking between rural providers and urban specialists, whose skills were needed to optimally treat patients with high acuity ulcers. Urban referrals, particularly to vascular surgery or infectious disease, were stymied by 1) time-consuming processes, 2) negative provider interactions, and 3) multiple, disconnected electronic health record systems. Such barriers ultimately detracted from rural PCPs’ ability to focus on medical management, as well as urban specialists’ ability to appropriately triage referrals due to lacking information. Subsequent collaboration between providers also suffered as a result.

Conclusions
Poor connections across rural and urban healthcare systems was described as the primary health system barrier driving the rural disparity in major amputations. Future interventions focusing on mitigating this barrier could reduce the rural disparity in major amputations.
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NewsBot · Jan 15, 2021

The analysis for time of referral to a medical center among patients with diabetic foot infection
Cheng-Wei Lin, Hui-Mei Yang, Shih-Yuan Hung, I-Wen Chen & Yu-Yao Huang
BMC Family Practice volume 22, Article number: 16 (2021)

Background
Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking.

Methods
This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed.

Results
One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028).

Conclusions
The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested.
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NewsBot · Apr 18, 2021

Diabetic Foot Delay and Diabetic Foot Push
Amit Kumar C Jain
IAR Journal of Medical Sciences | IAR J Med Sci, 2(2); | Volume 2: Issue:2 ( April 2, 2021 ) : 102- 103.

Diabetic foot is a common known complication of diabetes which can lead to amputation causing misery to the patient. It is known to cause increased morbidity and mortality. The burden of diabetic foot is rising both in developed and developing country. If a patient is from lower socioeconomic background, then it will dent him financially once he develops a complication. With such a dangerous scenario seen in most developing countries, prevention of diabetic foot is the best solution and there have been various methods of prevention. Various new terms have been coined in field of diabetic foot. The author in this article introduces 2 new terms namely the diabetic foot delay and the diabetic foot push. These terms will help in raising the awareness of diabetic foot and its problems and assist in interventions that can prevent diabetic foot complications
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NewsBot · Oct 14, 2021

Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays
Benjamin Bouillet et al
J Wound Care. 2021 Oct 2;30(10):804-808

Objective: Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral.

Method: In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included.

Results: Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004).

Conclusion: The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes.
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NewsBot · Jan 20, 2022

Amputation as a First Treatment is Highly Associated With Late Presentation: An Underestimated Modifiable Major Risk Factor for Diabetic Foot Ulcer
Kaissar Yammine et al
Foot Ankle Spec. 2021 Dec 30

Purpose: Several risk factors for lower extremity amputation in diabetic patients have been identified; however, late presentation has been poorly investigated. Very few studies looked at the impact of such risk factor. As none has investigated the link between admission to amputation and late presentation in this population, we investigated such association.

Methods: The study is a retrospective comparative cohort of continuous series of patients admitted for amputation related to diabetic foot ulcer (DFU) as a first treatment. A late presentation was defined as a period of 3 weeks or more from the onset of the ulcer.

Results: Forty-six patients admitted for amputation and all wounds were infected and located on the plantar forefoot in 32 cases (69.5%), on the toes in 10 cases (21.7%), and in the heel area in 4 cases (8.8%). The mean duration to admission was 5.2 ±1.8 weeks (range 4-10 weeks). Late presentation was recorded in 42 (91.3%) patients.

Conclusion: This study demonstrates that amputation due to DFU is highly associated with late presentation. Educational campaigns targeting patient and first-line health care providers and highlighting the urgency of diabetic ulcers are needed to impact this major modifiable risk factor
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NewsBot · Jul 19, 2022

How patients interpret early signs of foot problems and reasons for delays in care: Findings from interviews with patients who have undergone toe amputations
Alyson J Littman et al
PLoS One. 2021 Mar 10;16(3):e0248310.

Aims: To describe how patients respond to early signs of foot problems and the factors that result in delays in care.

Methods: Semi-structured interviews were conducted with a large sample of Veterans from across the United States with diabetes mellitus who had undergone a toe amputation. Data were analyzed using inductive content analysis.

Results: We interviewed 61 male patients. Mean age was 66 years, 41% were married, and 37% had a high school education or less. The patient-level factors related to delayed care included: 1) not knowing something was wrong, 2) misinterpreting symptoms, 3) "sudden" and "unexpected" illness progression, and 4) competing priorities getting in the way of care-seeking. The system-level factors included: 5) asking patients to watch it, 6) difficulty getting the right type of care when needed, and 7) distance to care and other transportation barriers.

Conclusion: A confluence of patient factors (e.g., not examining their feet regularly or thoroughly and/or not acting quickly when they noticed something was wrong) and system factors (e.g., absence of a mechanism to support patient's appraisal of symptoms, lack of access to timely and convenient-located appointments) delayed care. Identifying patient- and system-level interventions that can shorten or eliminate care delays could help reduce rates of limb loss.
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NewsBot · Mar 14, 2023

Analysis of pre-hospital delay in Chinese patients with diabetic foot ulcers: Based on 46 cases
Qiaoyue Ge et al
Int Wound J. 2023 Mar 14

To study the causes of pre-hospital delay in Chinese patients with diabetic foot ulcers (DFUs). A retrospective study, investigating a case series of 46 DFUs treated at a single hospital, was conducted to evaluate wound condition, wound treatment, costs, and patients' complete medical records, and analyse the reasons causing the pre-hospital delay. We assessed 46 DFUs aged between 53 and 92 years old. The average pre-hospital delay was 5 months, with nearly 20% being delayed for more than 1 year. The average length of hospital stay in China was 21 days, with an average cost of $8672. Recurrence rate of DFUs was 21%, and three patients were recommended to transfer to upper-level hospital. Besides, the intervention was limited and homogenous and medical records were incomplete. Medical service users' limited understanding of diseases, high costs that patients need to afford, and unsatisfactory treatment by medical service providers are the main reasons for patients' delay in seeking treatment. Recommendations are offered to reduce the pre-hospital delay of Chinese patients with DFUs.
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NewsBot · May 9, 2023

A new referral pathway to the multidisciplinary team for inpatients with diabetic foot pathology
Madeline Brazell , Muzammil Nahaboo Solim , Natalia Rios Turek & Simon Ashwell
Endocrine Abstracts (2023) 90 P605 | DOI: 10.1530/endoabs.90.P605

Background: In any given week, 2.5% of diabetic patients have a foot ulcer. In the United Kingdom (UK), there are 7000 lower limb amputations in people with diabetes every year and the annual NHS expenditure on diabetic foot-related healthcare amounts to £1 billion. As per the National Institute for Health and Care Excellence guidelines in the UK, a person with diabetes needs to be referred to an MDT within 24 h of finding a foot ulcer. The National Diabetes Footcare Audit demonstrates better outcomes at 12 weeks for patients with a new diabetic foot ulcer referred early for MDT input. The early identification of patients with a diabetic foot ulcer and a timely referral to the MDT is therefore vital.

Methods: A two-cycle quality improvement project, with retrospective data collection before and after our intervention, was carried out at our hospital with the aim of improving identification of patients and quality of referrals. Those information mainly included ulcer charateristics, past medical history and investigations. An online referral system with a pre-set questions was then introduced along with teaching sessions delivered to the acute medical team. The results were analysed and presented to the endocrinology and diabetes department.

Results: Our results showed that the average monthly number of referrals was 10.3 for the first cycle and 12.5 for the second cycle. The average referral time was 8.3 days for the first cycle and 4.2 days for the second cycle. Size of ulcer reporting improved from 6.5% to 64%, depth of ulcer from 9.7% to 12.0% and position of ulcer from 74.19% to 80.0%. Mention of peripheral vascular disease improved from 9.7% to 20.0%, presence of pulse from 12.9% to 100% and presence of neuropathy from 12.9% to 100.0%. For investigations, mention of microbiology culture results improved from 12.9% to 40.0% and imaging from 22.6% to 60.0%.

Conclusion: There has been an improvement in the time from admission until referral although more work needs to be done to improve the time to within the 24 hour window. The online referral system helped to improve the quality of information of the referral with regards to information on ulcer characteristics, past medical history and investigations. Improved quality of referrals allow for a more efficient MDT functioning and more timely management strategies for patient outcomes. We intend to further continue this project to look at the effect of the referral system on patient outcomes.
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NewsBot · May 14, 2023

A novel Canadian multidisciplinary acute care pathway for people hospitalised with a diabetic foot ulcer
Abdelrahman Zamzam, Ann-Marie McLaren, Emily Ram, Muzammil H. Syed, Sreenath Rave, Suzanne H. Lu, Mohammed Al-Omran, Charles de Mestral
07 May 2023

This manuscript describes the implementation and initial evaluation of a novel Canadian acute care pathway for people with a diabetic foot ulcer (DFU). A multidisciplinary team developed and implemented an acute care pathway for patients with a DFU who presented to the emergency department (ED) and required hospitalisation at a tertiary care hospital in Canada. Processes of care, length of stay (LOS), and hospitalisation costs were considered through retrospective cohort study of all DFU hospitalizations from pathway launch in December 2018 to December 2020. There were 82 DFU-related hospital admissions through the ED of which 55 required invasive intervention: 28 (34.1%) minor amputations, 16 (19.5%) abscess drainage and debridement, 6 (7.3%) lower extremity revascularisations, 5 (6.1%) major amputations. Mean hospital LOS was 8.8 ± 4.9 days. Mean hospitalisation cost was $20 569 (±14 143): $25 901 (±15 965) when surgical intervention was required and $9279 (±7106) when it was not. LOS and hospitalisation costs compared favourably to historical data. An acute care DFU pathway can support the efficient evaluation and management of patients hospitalised with a DFU. A dedicated multidisciplinary DFU care team is a valuable resource for hospitals in Canada
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NewsBot · Jul 31, 2023

Fast-Track Pathway: An Effective Way to Boost Diabetic Foot Care
Narges lashkarbolouk et al
Source

Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients’ knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway’s main objectives is to prevent the patient from getting the first ulcer, prevent frequent recurrence ulcers, and most importantly, prevent minor and major amputation.
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NewsBot · Dec 11, 2023

The impact of community teaching sessions on onward referral to specialist diabetic foot services
Nina Al-Saadi et al
Prim Care Diabetes. 2023 Nov 28:S1751-9918(23)00188-2

Introduction: Prompt referral of patients with diabetic foot ulceration (DFU) to specialist services can lead to more timely assessment of these patients and subsequent improved rates of limb salvage and patient outcomes. In this study we wanted to determine the impact of education in the primary care setting on onward referrals to our specialist Diabetic Foot multi-disciplinary team (MDT) clinic.

Methods: As part of a Diabetic Foot Roadshow, four teaching sessions were delivered in primary care settings across Shropshire by our specialist team from 17th March to the 25th May 2022. Attendees included podiatrists, tissue viability nurses, district nurses and wound care practitioners. Hospital records were used to identify all onward referrals to our Diabetic Foot MDT clinic in the weeks before and after delivery of the roadshow education sessions.

Results: 184 referrals were made to the diabetic foot clinic from January to July 2022. There were 0.3 referrals per day in the months prior to the commencement of the education sessions, compared to 1.5 referrals per day following the commencement of the teaching sessions. This increase in referrals was statistically significant (p < 0.0001).

Conclusion: Teaching sessions delivered to community specialist healthcare professionals significantly increase onward referral of patients to specialist services, facilitating more timely assessment and management of patients with DFUs.
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NewsBot · Dec 12, 2023

A qualitative study to analyse the reasons for delayed medical treatment in diabetic foot patients based on a health ecology model
Yanan DONG; Xiangqing LI; Xiaorui JIANG; Juntao CHI.
Chinese Journal of Practical Nursing ; (36): 865-870, 2023.

Objective:
To explore the reasons for delayed medical treatment in diabetic foot patients using the health ecology model as a framework.
Methods:
From November of 2021 to March of 2022, descriptive phenomenological research methods was used in 20 patients with diabetic foot who delayed medical treatment were interviewed face-to-face semi-structured in depth, and the data analysis was carried out using the seven-step method of Colaizzi phenomenology to refine the theme.
Results:
According to the five levels of the health ecology model, the reasons for delayed medical treatment were summarized into 11 themes, and the reasons for the personal trait layer included foot ulcers are not detected promptly, and the perceptual decline of advanced patients. Behavioral characteristics included lack of knowledge of diabetic foot, negative medical psychology. Reasons for the interpersonal network included insufficient family support and lack of social support; reasons for living and working conditions included high economic pressure, low electronic health literacy, and inconvenient medical treatment; the reasons for the policy environment included uneven medical insurance reimbursement ratios and limited medical conditions.
Conclusions:
The reason for the delay in seeking medical treatment for diabetic foot patients is multi-layered and systematic, and medical staff need to improve the self-management ability of diabetic patients′ feet from the individual level, and also need to guide patients from the system level on how to obtain the best medical resources.
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NewsBot · Jan 4, 2024

The impact of community teaching sessions on onward referral to specialist diabetic foot services
Nina Al-Saadi et al
Prim Care Diabetes. 2023 Nov 28

Introduction: Prompt referral of patients with diabetic foot ulceration (DFU) to specialist services can lead to more timely assessment of these patients and subsequent improved rates of limb salvage and patient outcomes. In this study we wanted to determine the impact of education in the primary care setting on onward referrals to our specialist Diabetic Foot multi-disciplinary team (MDT) clinic.

Methods: As part of a Diabetic Foot Roadshow, four teaching sessions were delivered in primary care settings across Shropshire by our specialist team from 17th March to the 25th May 2022. Attendees included podiatrists, tissue viability nurses, district nurses and wound care practitioners. Hospital records were used to identify all onward referrals to our Diabetic Foot MDT clinic in the weeks before and after delivery of the roadshow education sessions.

Results: 184 referrals were made to the diabetic foot clinic from January to July 2022. There were 0.3 referrals per day in the months prior to the commencement of the education sessions, compared to 1.5 referrals per day following the commencement of the teaching sessions. This increase in referrals was statistically significant (p < 0.0001).

Conclusion: Teaching sessions delivered to community specialist healthcare professionals significantly increase onward referral of patients to specialist services, facilitating more timely assessment and management of patients with DFUs.
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NewsBot · Jan 25, 2024

Psychosocial markers of pre-hospital delay in patients with diabetic foot: A cross-sectional survey
Huiwen Xu et al
Nurs Open. 2024 Jan;11(1):e2088

Aim: This study aimed to determine the psychosocial markers associated with pre-hospital delay among patients with diabetic foot (DF).

Design: This study has a cross-sectional design.

Methods: The participants completed a questionnaire including pre-hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale-14. Bivariate and multivariate analyses were conducted to explore independent associations with pre-hospital delay.

Results: Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay.

Implications for the profession and/or patient care: Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self-management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes.

Patient or public contribution: This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China.
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NewsBot · Apr 17, 2024

Inequity of healthcare access for patients with diabetic foot disease: a retrospective study in south-east Queensland
Yudish Kumar Soonarane et al
Source

Objectives Logan local government area (LGA) in Queensland has the highest diabetes prevalence (6.5%) within Metro South Health (MSH). The study aimed to determine the burden of, and equity of access to secondary healthcare, for diabetic foot disease (DFD) for Logan residents to better inform healthcare services planning.

Design A retrospective analysis of hospital admissions data between January 2018 and December 2021.

Setting, participants All episodes of care for DFD provided by MSH hospitals to patients with a residential address in the three LGAs serving the region were included.

Primary and secondary outcome measures Primary outcome was number of episodes of care for DFD by LGA of residence and hospital of presentation. Secondary outcomes were DFD-related hospital occupied bed days and number of lower extremity amputations.

Results Among residents in the MSH region, almost half of all episodes of care (47%) and bed days (48%) for DFD were for patients residing in Logan LGA. 40% of episodes of care, 57% of bed days and 73% of lower extremity amputations for DFD for these patients occurred outside of Logan LGA. These findings led to the planning of an integrated model of care for DFD at Logan hospital to improve and make care available locally.

Conclusions Our study suggests that Logan residents with DFD had poor access to care despite the highest burden. Analysing epidemiology of care for DFD with an equity lens and highlighting gaps in service delivery is paramount to addressing the inequity paradigm.
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