Barriers and enablers to providing preventative and early intervention diabetes-related foot care: a qualitative study of primary care healthcare professionals’ perceptions
Leanne Mullan![https://orcid.org/0000-0003-0182-2148](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0003-4620-7691](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-6837-0249](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-6789-8260](/media/client/orcid_16x16.png)
A Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.
B Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.
C Western Health Partnership, 176 Furlong Road, St Albans, Burwood, Vic. 3021, Australia.
D Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
E Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, DK-5230 Odense M, Denmark.
F Corresponding author. Email: mulea@deakin.edu.au
Australian Journal of Primary Health 27(4) 319-327 https://doi.org/10.1071/PY20235
Submitted: 8 October 2020 Accepted: 4 February 2021 Published: 16 April 2021
Abstract
This study explored the perceived healthcare system and process barriers and enablers experienced by GPs and Credentialled Diabetes Educators (CDEs) in Australian primary care, in the delivery of preventative and early intervention foot care to people with diabetes. A qualitative design with inductive analysis approach was utilised and reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Semi-structured interviews were conducted with two GPs and 14 CDEs from rural, urban and metropolitan areas of Australia. Participants were from New South Wales, South Australia, Victoria, Western Australia, the Northern Territory and Queensland. Barriers to providing foot care constituted five broad themes: (1) lack of access to footcare specialists and services; (2) education and training insufficiencies; (3) human and physical resource limitations related to funding inadequacies; (4) poor care integration such as inadequate communication and feedback across services and disciplines, and ineffectual multidisciplinary care; and (5) deficient footcare processes and guidelines including ambiguous referral pathways. Enablers to foot care were found at opposing ends of the same spectra as the identified barriers or were related to engaging in mentorship programs and utilising standardised assessment tools. This is the first Australian study to obtain information from GPs and CDEs about the perceived barriers and enablers influencing preventative and early intervention diabetes-related foot care. Findings offer an opportunity for the development and translation of effective intervention strategies across health systems, policy, funding, curriculum and clinical practice, in order to improve outcomes for people with diabetes.
Keywords: primary health care, diabetic foot, diabetes, prevention, Australia, foot disease, general practitioner, nurse.
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