Podiatrist care and outcomes for patients with diabetes and foot ulcer

Abstract

We examined whether outcomes of care (amputation and hospitalisation) among patients with diabetes and foot ulcer differ between those who received pre-ulcer care from podiatrists and those who did not. Adult patients with diabetes and a diagnosis of a diabetic foot ulcer were found in the MarketScan Databases, 2005-2008. Multivariate Cox proportional hazard models estimated the hazard of amputation and hospitalisation. Logistic regression estimated the likelihood of these events. Propensity score weighting and regression adjustment were used to adjust for potentially different characteristics of patients who did and did not receive podiatric care. The sample included 27 545 patients aged greater than 65+ years (Medicare-eligible patients with employer-sponsored supplemental insurance) and 20 208 patients aged lesser than 65 years (non Medicare-eligible commercially insured patients). Care by podiatrists in the year prior to a diabetic foot ulcer was associated with a lower hazard of lower extremity amputation, major amputation and hospitalisations in both non Medicare-eligible commercially insured and Medicare-eligible patient populations. Systematic differences between patients with diabetes and foot ulcer, receiving and not receiving care from podiatrists were also observed; specifically, patients with diabetes receiving care from podiatrists tend to be older and sicker.

Diabetic foot disease in Indigenous people

“…Here we will consider three issues that impact on access -cultural appropriateness, community engagement and funding. Accessibility is central to the performance of healthcare systems and is a critical component of equity [83]. Access is complex, and involves a dynamic interaction between health systems, organizations and services providers, and individual and community factors.…”

“…For example, care by podiatrists in the year preceding a diabetic foot ulcer was associated with a lower hazard of LEA and hospitalization in US Medicare and non-Medicare populations [83]. Tribal corporations in Alaska used a portion of their Special Diabetes Program for Native American funding to implement a high-risk foot program that enabled diabetic foot clinics to be delivered routinely in urban and remote settings -and this resulted in reduced amputations [84].…”

Development of grading scales of pedal sensory loss using Mokken scale analysis on the Rotterdam Diabetic Foot Study Test Battery data

“…Therefore, an individualized approach with recommendations regarding intervention strategies and patient information may be feasible. [64][65][66][67]…”

All Feet on Deck: The Role of Podiatry During the COVID-19 Pandemic: Preventing Hospitalizations in an Overburdened Health-Care System, Reducing Amputation and Death in People with Diabetes

“…Good, regular podiatric care has been shown to reduce diabetes-related ER visits, hospitalization, length-of-stay, and amputations. [12][13][14][15][16][17] A large percentage of outpatient wound centers are located in the physical space of the hospital, which is unique among all outpatient service lines, for both billing reasons (hospitals charge facility fees) and safety considerations (ability to respond to hyperbaric oxygen treatment emergencies). However, in the coming months, we anticipate that many wound centers will close because of guidance from the US Surgeon General, CMS, and state/local governments to reduce outpatient traffic in the hospital and non-essential services.…”