An evaluation of community-based resources for management of diabetes-related foot disorders in an Australian population

BackgroundThere is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia.MethodsAdults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis.ResultsEight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82–3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22–4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35–4.86).ConclusionsA high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.

Section: Discussionmentioning

confidence: 99%

The foot‐health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study

Perrin

Allen

Gardner

et al. 2019

“…Other Australian studies reporting higher use of the diabetic foot guidelines sampled podiatrists only, rather than the multidisciplinary sample in this study [ 57 , 58 ]. Improvement in healthcare practitioners’ diabetic foot knowledge in multidisciplinary samples has been shown in other studies using a pre/post-test design and continuing medical education [ 33 – 35 ].…”

Section: Discussionmentioning

confidence: 99%

Improving rural and remote practitioners' knowledge of the diabetic foot: findings from an educational intervention

Schoen

Gausia

Glance

et al. 2016

BackgroundThis study aimed to determine knowledge of national guidelines for diabetic foot assessment and risk stratification by rural and remote healthcare professionals in Western Australia and their implementation in practice. Assessment of diabetic foot knowledge, availability of equipment and delivery of foot care education in a primary healthcare setting at baseline enabled evaluation of the effectiveness of a diabetic foot education and training program for generalist healthcare professionals.MethodsThis study employed a quasi-experimental pre-test/post-test study design. Healthcare practitioners’ knowledge, attitudes and practice of diabetic foot assessment, diabetic foot risks, risk stratification, and use of the 2011 National Health and Medical Research Council Guidelines were investigated with an electronic pre-test survey. Healthcare professionals then undertook a 3-h education and training workshop before completing the electronic post-test knowledge, attitudes and practice survey. Comparison of pre-test/post-test survey findings was used to assess the change in knowledge, attitudes and intended practice due to the workshops.ResultsTwo hundred and forty-six healthcare professionals from two rural and remote health regions of Western Australia participated in training workshops. Monofilaments and diabetes foot care education brochures, particularly brochures for Aboriginal people, were reported as not readily available in rural and remote health services. For most participants (58 %), their post-test knowledge score increased significantly from the pre-test score. Use of the Guidelines in clinical settings was low (19 %). The healthcare professionals’ baseline diabetic foot knowledge was adequate to correctly identify the high risk category. However, stratification of the intermediate risk category was poor, even after training.ConclusionThis study reports the first assessment of Western Australia’s rural and remote health professionals’ knowledge, attitudes and practices regarding the diabetic foot. It shows that without training, generalists’ levels of knowledge concerning the diabetic foot was low and they were unlikely to assess foot risk. The findings from this study in a rural and remote setting cast doubt on the ability of generalist healthcare professionals to stratify risk appropriately, especially for those at intermediate risk, without clinical decision support tools.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0157-2) contains supplementary material, which is available to authorized users.

“…Most of the recommendations outlined in Australian National Evidence-Based Guideline on the Prevention, Identification and Management of Foot Complications in Diabetes apply directly to care provided by podiatrists [ 4 ]. However, there is limited literature examining how podiatrists’ clinical practice reflects evidence based practice in Australia [ 10 , 16 ]. One study surveying podiatry centres in Victoria reported over 60% of centres broadly used clinical guidelines when managing patients with diabetic foot disorders but did not provide further detail about compliance with specific guideline recommendations [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, there is limited literature examining how podiatrists’ clinical practice reflects evidence based practice in Australia [ 10 , 16 ]. One study surveying podiatry centres in Victoria reported over 60% of centres broadly used clinical guidelines when managing patients with diabetic foot disorders but did not provide further detail about compliance with specific guideline recommendations [ 16 ]. It has also been identified that the Australian Government’s Medical Benefits Schedule (MBS) does not attribute funding to many of the key evidence based recommendations outlined in the Australian guidelines, such as total contact casting or other devices rendered irremovable [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the availability of diabetic foot guidelines and the evidence for their use in improving patient outcomes, the recommendations found within these guidelines are not always adhered to in clinical practice [14][15][16][17][18]. Studies performed in the US report low compliance with certain guideline recommendations in diabetic foot care [14,15].…”

Section: Introductionmentioning

confidence: 99%

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How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey

Quinton

Lazzarini

Boyle

et al. 2015

BackgroundDiabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors’ knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists’ diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council.MethodsA 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups.ResultsThree hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11–15 years median experience. Participants reported treating a median of 21–30 diabetes patients each week, including 1–5 with foot ulcers. Overall, participants registered median scores of at least “very often” (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: “never” (1 (1 – 3)) using total contact casting, “sometimes” (4 (2 – 5)) performing an ankle brachial index, “sometimes” (4 (1 – 6)) using University of Texas Wound Classification System, and “sometimes” (4 (3 – 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01).ConclusionsThis study provides the first baseline information on Australian podiatrists’ adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations.