Multidisciplinary clinics reduce treatment costs and improve patient outcomes in diabetic foot disease

Joret, Maximilian O.; Osman, Kareem; Dean, Anastasia; Cao, Colin; Werf, Bert van der; Bhamidipaty, Venu

doi:10.1016/j.jvs.2018.11.032

Cited by 62 publications

(50 citation statements)

References 28 publications

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“…One included cohort study had 4 substudies [41] and another, 2 substudies [38]. Reasons for exclusion (consensus between authors) were: mixed data when reporting primary outcome [42], eminent difference of basic population [43][44][45], podiatric interventions pre and post cohort [46] and incomplete data for pooling the outcomes [40,[47][48][49][50][51].…”

Section: Literature Searchmentioning

confidence: 99%

“…Podiatrists are sole leaders in one article [48]. In 8 articles, they had a secondary role (support to the MDT but without a leading role) [45,46,49,51,56,58,60,61] and in 2 articles, they had a tertiary role (external consultation when needed) [38,42]. Podiatrists' role was similar to other team members in two articles [50,57] .…”

Section: Description Of Included Articlesmentioning

confidence: 99%

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Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Blanchette

Brousseau-Foley

Cloutier

2020

Journal of Foot and Ankle Research

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Multidisciplinary team (MDT) approach has been shown to reduce diabetic foot ulcerations (DFUs) and lower extremity amputations (LEAs), but there is heterogeneity between team members and interventions. Podiatrists have been suggested as "gatekeepers" for the prevention and management of DFUs. The purpose of our study is to review the effect of podiatric interventions in MDTs on DFUs and LEAs. We conducted a systematic review of available literature. Data's heterogeneity about DFU outcomes made it impossible for us to include it in a meta-analysis, but we identified 12 studies fulfilling inclusion criteria that allowed for them to be included for LEA outcomes. With the exception of one study, all reported favourable outcomes for MDTs that include podiatry. We found statistical significance in favour of an MDT approach including podiatrists for our primary outcome (total LEAs (RR: 0.69, 95% CI 0.54-0.89, I 2 = 64%, P = 0.002)) and major LEAs (RR: 0.45, 95% CI 0.23-0.90, I 2 = 67%, P < 0.02). Our systematic review, with a standard search strategy, is the first to specifically address the relevant role of podiatrists and their interventions in an MDT approach for DFU management. Our observations support the literature that MDTs including podiatrists have a positive effect on patient outcomes but there is insufficient evidence that MDTs with podiatry management can reduce the risk of LEAs. Our study highlights the necessity for intervention descriptions and role definition in team approach in daily practice and in published literature.

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Section: Literature Searchmentioning

confidence: 99%

Section: Description Of Included Articlesmentioning

confidence: 99%

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Blanchette

Brousseau-Foley

Cloutier

2020

Journal of Foot and Ankle Research

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“…63 Studies across multiple countries have also shown that the implementation of a multidisciplinary team reduced major amputations leading to significant cost savings. [64][65][66] Using Markov models, diabetic patients treated by multidisciplinary teams with preventative measures lead to savings of $2,900 to $4,442 per patient costs. 67…”

Section: The Role Of Multidisciplinary Teams In the Care Of Cltimentioning

confidence: 99%

The Role of Lower Extremity Amputation in Chronic Limb-Threatening Ischemia

2020

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Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease associated with high rates of limb loss. The primary goal of treatment in CLTI is limb salvage via revascularization. Multidisciplinary teams provide improved care for those with CLTI and lead to improved limb salvage rates. Not all patients are candidates for revascularization, and a subset will require major amputation. This article highlights the role of amputations in the management of CLTI, and describes the patients who should be offered primary amputation.

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“…Sonuçlar bu merkezin kurulumunun hasta sonuçlarını iyileştirdiğini ve tedavi maliyetini düşürdüğünü göstermiştir. Ortak görüş multidisipliner diyabetik ayak bakım kliniklerinin, diyabetik ayak hastaları için bakım standardı olarak benimsenmesi yönünde olmuştur (23) . Bir başka çalışmada Diyabetik ayak servisi kurulumuyla 11 yıllık süreçte majör amputasyon oranı %62, tüm ampütasyonlarda ise %40 oranında düşüş sağlanmıştır (24) .…”

Section: Gereç Ve Yöntemunclassified

Investigation of Diabetic Foot Diagnosis and Treatment Processes in Provincial Education and Research Hospitals and the Need for a New Perspective on the Processes

Bayrak¹,

Aslan²,

Tekeşin³

et al. 2020

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Sonuç: DA hastalarının farklı polikliniklere başvurması nedeniyle takip süreçleri kontrol edilememektdir. DA yarası olan hastaların sabit bir poliklinikten girişlerinin yapılması, tedavi süreçlerinin ve takiplerinin buradan yönetilmesi ile süreçler kontrol edilebilecek, multidisipliner olarak hastaların değerlendirilmesi ve tedavi uygulamaları ile de ekstremite koruyucu tedavi başarı oranınının artması yanında maliyette azalma sağlanacaktır.

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Multidisciplinary clinics reduce treatment costs and improve patient outcomes in diabetic foot disease

Cited by 62 publications

References 28 publications

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta‐analysis

The Role of Lower Extremity Amputation in Chronic Limb-Threatening Ischemia

Investigation of Diabetic Foot Diagnosis and Treatment Processes in Provincial Education and Research Hospitals and the Need for a New Perspective on the Processes

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