Availability and service provision of multidisciplinary diabetes foot units in Australia: a cross‐sectional survey

Abstract

Background With growing global prevalence of diabetes mellitus, diabetes-related foot disease (DFD) is contributing significantly to disease burden. As more healthcare resources are being dedicated to the management of DFD, service design and delivery is being scrutinised. Through a national survey, this study aimed to investigate the current characteristics of services which treat patients with DFD in Australia. Methods An online survey was distributed to all 195 Australian members of the Australian and New Zealand Society for Vascular Surgery investigating aspects of DFD management in each member’s institution. Results From the survey, 52 responses were received (26.7%). A multidisciplinary diabetes foot unit (MDFU) was available in more than half of respondent’s institutions, most of which were tertiary hospitals. The common components of MDFU were identified as podiatrists, endocrinologists, vascular surgeons and infectious disease physicians. Many respondents identified vascular surgery as being the primary admitting specialty for DFD patients that require hospitalisation (33/52, 63.5%). This finding was consistent even in centres with MDFU clinics. Less than one third of MDFUs had independent admission rights. Conclusions The present study suggests that many tertiary centres in Australia provide their diabetic foot service in a multidisciplinary environment however their composition and function remain heterogeneous. These findings provide an opportunity to evaluate current practice and, to initiate strategies aimed to improve outcomes of patients with DFD.

Establishing the national top 10 priority research questions to improve diabetes-related foot health and disease: a Delphi study of Australian stakeholders

“…Multidisciplinary DFD services have long been shown to significantly improve health outcomes 23–25 and implementation of best practice DFD treatments has been shown to be cost-effective in managing DFD. 26–28 However, global research has also shown that multidisciplinary DFD services are heterogenous in composition and function, 29 30 and implementation of best practice treatments is infrequent in real-world practice. 31 32 Thus, perhaps it is no surprise that Australian DFD stakeholders are most interested in testing and identifying the health and economic outcomes of existing services.…”

The interplay between patients with diabetic foot ulcer and healthcare professionals in a cross-sectorial setting addressing treatment and care; A realistic evaluation.

“…Furthermore, the complex intervention demands a cross-sectional setting and collaboration between the patient and the healthcare professionals involved. In addition, the treatment and care is often taking place in both primary care and in a specialist settings (hospital outpatient clinic ) (9).…”

Innovative and accessible multidisciplinary care is needed to improve diabetes‐related foot disease outcomes in Australia and New Zealand

“…8,9 However, implementation of MDT care is poor, with a 2017 survey showing that only 60% of responding Australian vascular surgeons have a MDT diabetic foot unit at their institution. 10 The article by Berhane et al, included in this journal edition highlights an important intervention to reduce limb loss in people living with DFD in Darwin, Northern Territory, Australia. 11 As the authors comment, the Northern Territory has the highest amputation rate per capita in Australia.…”

“…A multi‐disciplinary team (MDT) approach has been shown to reduce major amputations by 39–56%, as well as reduce hospital admissions and the total cost of treatment for a diabetic foot wound 8,9 . However, implementation of MDT care is poor, with a 2017 survey showing that only 60% of responding Australian vascular surgeons have a MDT diabetic foot unit at their institution 10 …”