Improving foot care for people with diabetes mellitus – a randomized controlled trial of an integrated care approach

Donohoe, M. E.; Fletton, John Alan; Hook, Alyssa N.; Powell, Roy; Robinson, Idris; Stead, Jonathan; Sweeney, Kathleen; Taylor, Rachel M; Tooke, John E.

doi:10.1046/j.1464-5491.2000.00336.x

Cited by 80 publications

(70 citation statements)

References 12 publications

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“…The GP education intervention group included peer review and feedback (n = 4), [10][11][12][13] interventions which consisted of formal GP training (including continued professional development) (n = 17), [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] additional formal training and support for practitioners). The overall picture for interventions that aim to moderate referral processes by educating GPs is mixed, but some groups of interventions with more positive outcomes have been identified, including in particular peer review and feedback interventions (positive effects on referral, expenditure, and referral letter quality), as well as some elements of formal GP training (positive effects on referral rate, appropriate referrals, GP knowledge, consultation quality, and patient waiting time).…”

Section: Box 1 Main Search Strategymentioning

confidence: 99%

Referral interventions from primary to specialist care: a systematic review of international evidence

et al. 2014

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BackgroundDemand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. AimTo review the international evidence on interventions to manage referral from primary to specialist care. Design and settingSystematic review. MethodIterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. ResultsThe searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts.

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Section: Box 1 Main Search Strategymentioning

confidence: 99%

Referral interventions from primary to specialist care: a systematic review of international evidence

et al. 2014

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“…Patients with lower extremity PAD and diabetes should be treated to reduce their glycosylated hemoglobin to less than 7%, per the American Diabetes Association recommendation (40). Frequent foot inspection by patients and physicians will enable early identification of foot lesions and ulcerations and facilitate prompt referral for treatment (41). Physician advice coupled with frequent follow-up achieves 1-year smoking cessation rates of approximately 5% compared with only 0.1% in those attempting to quit smoking without a physician's intervention (42).…”

Section: Angiotensin-converting Enzyme Inhibitors May Be Considered Fmentioning

confidence: 99%

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery,⁎⁎AAVS/SVS when Guideline initiated, now merged into SVSSociety for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guideline

Hirsch¹,

Haskal²,

Hertzer³

et al. 2006

Journal of the American College of Cardiology

923

180

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“…One hospital-based CM was reported to improve diabetes care, patient outcome, partnership between hospital medical team workers and community health resources, as well as the implementation of guidelines [6]. Another integrated hospital approach focusing on foot care for DFS patients improved primary care staff s' knowledge and patients' attitudes, and the number of appropriate referrals to acute specialist services was increased [8]. Th e integration of a "Diabetic Foot Practioneer" into a clinical diabetic foot care team [9] who managed a fast-track vascular program for ischemic patients reduced the mean LOS from 59 to 34 days.…”

Section: Discussionmentioning

confidence: 99%

Readmissions of patients with diabetes mellitus and foot ulcers after infra-popliteal bypass surgery - attacking the problem by an integrated case management model

Rümenapf

Geiger

Schneider

et al. 2013

Vasa

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SummaryBackground: Patients with neuroischemic diabetic foot syndrome (DFS) may need arterial revascularization, minor amputations, débridements as well as meticulous wound care. Unfortunately, postoperative outpatient care is frequently inadequate. Th is is especially true for Germany, where the in-and outpatient sectors are funded and managed separately, with poor communication between the two. Th us, many patients may be readmitted to the hospital following successful treatment and discharge. In an attempt to overcome these problems, we looked at whether an integrated case management (CM) system for outpatient care according to in-hospital standards might improve patients care and avoid readmissions. In addition we analyzed the length of hospital stay (LOS) as well as hospital costs. Patients and methods: In this retrospective cohort study patients with DFS, bypass surgery and foot surgery aft er implementation of the CM (study group; n = 376) were compared with a matched historic control group (HCG; n = 190) including the fl at rate revenues (G-DRG K01B). Following a standardized assessment, integrated trans-sectoral CM care was off ered to 116 patients (CMP). Results: Th e proportion of patients who were readmitted to hospital was reduced in CMP compared to HCG (8.8 vs. 16.4 %; p < 0.01), with consequent reduction of case consolidations (9.7 % versus 17.8 %, p < 0.001). Although initially, the mean LOS was higher in the CMP patients, the reduction in readmissions meant that this integrated CM program improved the hospital's economic situation. Conclusions: A hospital-based integrated CM system signifi cantly reduces the hospital readmissions in patients with neuroischemic DFS following bypass surgery, with lower hospital costs.

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Improving foot care for people with diabetes mellitus – a randomized controlled trial of an integrated care approach

Abstract: Provision of integrated care arrangements for the diabetic foot has a positive impact on primary care staffs' knowledge and patients' attitudes resulting in an increased number of appropriate referrals to acute specialist services.

Cited by 80 publications

References 12 publications

Referral interventions from primary to specialist care: a systematic review of international evidence

Referral interventions from primary to specialist care: a systematic review of international evidence

Readmissions of patients with diabetes mellitus and foot ulcers after infra-popliteal bypass surgery - attacking the problem by an integrated case management model

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