An organised approach to the podiatric care of people with diabetes in regional Australia
Byron M. Perrin A D , Marcus J. Gardner B , Susan R. Kennett C , Jodie L. Cornelius B and Michael J. Fanning BA La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Vic. 3552, Australia.
B Bendigo Health, PO Box 126, Bendigo, Vic. 3552, Australia. Email: mgardner@bendigohealth.org.au; jcorneli@bendigohealth.org.au; mfanning@bendigohealth.org.au
C Bendigo Community Health Services, PO Box 1121, Bendigo, Vic. 3552, Australia. Email: susankennett@bchs.com.au
D Corresponding author. Email: b.perrin@latrobe.edu.au
Australian Health Review 36(1) 16-21 https://doi.org/10.1071/AH11010
Submitted: 11 February 2011 Accepted: 25 July 2011 Published: 9 February 2012
Abstract
Objective. To ensure an efficient publicly funded podiatric service for people with diabetes in regional Victoria, a Podiatry Diabetes Model (PDM) of care was developed. The aim of this study was to determine if people with diabetes attended the most appropriate podiatric service as depicted by the model.
Methods. A 3-month prospective clinical audit of the PDM was undertaken. Primary variables of interest were the podiatric service where the patients were seen and the patients’ risk of future foot morbidity. Chi-square analyses for each service category were undertaken to compare the expected number of patients seen according to foot-health risk as predicted by the model, with what was observed.
Results. Five hundred and seventy-six people with diabetes were seen in the 3-month period. There was no statistically significant difference between the proportion of patients seen by each podiatric service according to risk status, with what was expected (community: χ2 = 3.3, P = 0.4; subacute: χ2 = 8.0, P = 0.05; acute: χ2 = 6.6, P = 0.09).
Conclusions. The Podiatry Diabetes Model is a sound podiatric model of care and is an example of cross-organisational collaboration that could be implemented in other areas of Australia.
What is known about the topic? Diabetes-related foot complications are a significant burden on health systems and individuals with diabetes. Podiatric services are important in the prevention and management of complications such as peripheral neuropathy, ulceration and lower limb amputation. It is important to organise healthcare systems to ensure appropriate and efficient services are provided for people with diabetes.
What does this paper add? This paper describes and tests a novel collaborative, multi-organisation podiatric model of care for people with diabetes in a large regional Australian setting.
What are the implications for practitioners? This paper demonstrates that it is possible to collaborate across multiple organisations to provide a comprehensive publicly funded podiatric service to people with diabetes that encompasses the entire risk spectrum for future diabetes-related foot complications.
References
[1] Diabetes: Australian facts 2008. Canberra: Australian Institute of Health and Welfare; 2008.[2] Reiber G, LeMaster J. Epidemiology and economic impact of foot ulcers and amputations in people with diabetes. In: Bowker J, Pfeiffer M, editors. Levin and O’Neals’ The diabetic foot. 7th edn. St Louis: Mosby Inc; 2008; pp. 3–22.
[3] Connor H, Mahdi OZ. Repetitive ulceration in neuropathic patients. Diabetes Metab Res Rev 2004; 20 S23–8.
| Repetitive ulceration in neuropathic patients.Crossref | GoogleScholarGoogle Scholar | 15150809PubMed |
[4] Vileikyte L, Peyrot M, Bundy C, Rubin RR, Leventhal H, Mora P, Shaw JE, Baker P, Boulton AJM. The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument. Diabetes Care 2003; 26 2549–55.
| The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument.Crossref | GoogleScholarGoogle Scholar | 12941717PubMed |
[5] Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration? J Am Podiatr Med Assoc 2008; 98 489–93.
| 19017860PubMed |
[6] Armstrong DG, Lavery LA, Harkless LB. Treatment-based classification system for assessment and care of diabetic feet. J Am Podiatr Med Assoc 1996; 86 311–6.
| 1:STN:280:DyaK28zjsVWltg%3D%3D&md5=a77cc7827c73e81fc452a2abea7343c7CAS | 8757481PubMed |
[7] Tapp RJ, Zimmet PZ, Harper CA, de Courten MP, Balkau B, McCarty DJ, Taylor HR, Welborn TA, Shaw JE. Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes. Diabetes Care 2004; 27 688–93.
| Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes.Crossref | GoogleScholarGoogle Scholar | 14988286PubMed |
[8] Harkless LB, Satterfield K, Dennis KJ. Role of the podiatrist in the care of the diabetic foot. In: Bowker J, Pfeiffer M, editors. Levin and O’Neal’s The diabetic fFoot. 7th ed. St Louis: Mosby, Inc.; 2008; pp. 505–20.
[9] Zhang H, Elkadi S. The Victorian podiatry workforce 2003–2007. Melbourne: Department of Human Services; 2009.
[10] Davidson P, Halcomb E, Hickman L, Phillips J, Graham B. Beyond the rhetoric: what do we mean by a ‘model of care’? Aust J Adv Nurs 2006; 23 47–55.
| 16568879PubMed |
[11] Harris MF, Chan BC, Dennis SM. Coordination of care for patients with chronic disease. Med J Aust 2009; 191 85–6.
| 19619092PubMed |
[12] Jackson CL, Nicholson C, Doust J, Cheung L, O’Donnell J. Seriously working together: integrated governance models to achieve sustainable partnerships between health care organisations. Med J Aust 2008; 188 S57–60.
| 18429738PubMed |
[13] Innovative care for chronic conditions: building blocks for action: global report. Geneva: World Health Organization; 2002.
[14] Diabetes model of care. Perth: Health Networks Branch, Department of Health, Western Australia; 2008.
[15] Bergin SM, Brand CA, Colman PG, Campbell DA. An evaluation of community-based resources for management of diabetes-related foot disorders in an Australian population. Aust Health Rev 2009; 33 671–8.
| An evaluation of community-based resources for management of diabetes-related foot disorders in an Australian population.Crossref | GoogleScholarGoogle Scholar | 20166917PubMed |
[16] Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med 1998; 158 157–62.
| Practical criteria for screening patients at high risk for diabetic foot ulceration.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7htVSjtg%3D%3D&md5=a2dac0e961fe129b1553a828bd939a27CAS | 9448554PubMed |
[17] Perrin B. A retrospective audit of a diabetic foot clinic. Australas J Podiatr Med 2006; 40 23–9.
[18] Abbott CA, Vileikyte L, Williamson S, Carrington AL, Boulton AJ. Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration. Diabetes Care 1998; 21 1071–5.
| Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czhslCkuw%3D%3D&md5=5c98af28acebc78752f74fc7057ab6d8CAS | 9653597PubMed |
[19] Tapp R, Shaw J, de Courten M, Dunstan D, Welborn T. Foot complications in type 2 diabetes: an Australian population-based study. Diabet Med 2003; 20 105–13.
| Foot complications in type 2 diabetes: an Australian population-based study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s%2FntFehug%3D%3D&md5=9c5ec1d36890abe35e2f22d3001a7d82CAS | 12581261PubMed |
