Primary care referral to multidisciplinary high risk foot services – too few, too late

Abstract

BackgroundTo determine if patients with no contact with a multi-disciplinary team High Risk Foot Service (MDT-HRFS) had an increased rate of hospital admission for diabetes foot infection compared to patients with contact. Secondary aims were to report on clinical outcomes.MethodsA retrospective study was conducted at a major tertiary referral hospital in metropolitan Sydney over 12 months. An ICD-10 search of the electronic medical record system and paper medical charts identified patients with diabetes mellitus (type 1 or type 2) and a primary admission for diabetes foot infection (DFI). Patients were categorised as having contact or no contact with an MDT-HRFS.ResultsOne hundred ninety-six hospital admissions (156 patients) were identified with DFI over a 12-month period. Patients with no contact with a MDT-HRFS represented three quarters of admissions (no contact = 116, 74.7 % vs. contact = 40, 25.6 %, p = 0.0001) and presented with more severe infection (no contact = 39 vs. contact = 12). The odds of lower extremity amputation increased five-fold when both no contact and severe infection occurred in combination (no contact with severe infection and amputation = 34, 82.9 % vs. contact with severe infection and amputation = 7, 17.1 %, OR 4.9, 95 % CI 1.1–21.4, p = 0.037). Using estimates of both the contact and no contact population of people with diabetes and high-risk feet and assuming the risk of amputation was the same, than the number of expected amputations in the no contact group should have been 55, however the observed number was 77, 22 more than expected (p = 0.0001).ConclusionsPatients with no contact with a MDT-HRFS represented the majority of admissions for DFIs to a tertiary referral hospital. This group on population estimates appears to be at high risk of amputation of the lower extremity and therefore early referral of this high-risk group might lower this risk.

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

“…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] .…”

“…According to our predefined secondary outcomes (Table 1), data was available for mortality/survival [36,41,43,54,58], recurrence [43,54,57], other complications [54,61,64], and healthcare data [49,54,56,57,59,61,63,64]. Meta-analyses were performed for some studies, but heterogeneity was over 75%.…”

Impact of Multidisciplinary Care of Diabetic Foot Infections for Inpatients at Campbelltown Hospital

“…Whilst the current literature on multidisciplinary teams and their role in the management of DFI suggests that MDTs improve the health outcomes of patients (7)(8)(9)(10)12), the impact of a MDT on LOS and the degree of surgical intervention is not well established. This audit aimed to determine the effect of MDT involvement had on LOS and surgical outcomes of DFI patients.…”

Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil

“…In our study, we found 27.1% of patients with previous antimicrobial use. These data were collected in order to try to correlate the use of antimicrobials with bacterial resistance, but this also serves to demonstrate the unsuccessful strategy of outpatient treatment in cases of DFI that evolve to moderate or severe due to the conditions of vascularization of the limbs [ 18 , 19 ].…”