Barriers to podiatric care among diabetic patients in the San Francisco Bay area

Patient and health care provider knowledge of diabetes and diabetic microvascular complications: a comprehensive literature review

Diabetic retinopathy, neuropathy, and nephropathy occur in more than 50% of people with diabetes, contributing substantially to morbidity and mortality. Patient understanding of these microvascular complications is essential to ensure early recognition and treatment of these sequalae as well as associated symptoms, yet little is known about patient knowledge of microvascular sequalae. In this comprehensive literature review, we provide an overview of existing knowledge regarding patient knowledge of diabetes, retinopathy, neuropathy, and nephropathy. We also discuss health care provider's knowledge of these sequalae given that patients and providers must work together to achieve optimal care. We evaluated 281 articles on patient and provider knowledge of diabetic retinopathy, neuropathy, and nephropathy as well as predictors of improved knowledge and screening practices. Results demonstrated that patient and provider knowledge of microvascular sequalae varied widely between studies, which may reflect sociocultural or methodologic differences. Knowledge assessment instruments varied between studies with limited validation data and few studies controlled for confounding. Generally, improved patient knowledge was associated with greater formal education, longer diabetes duration, and higher socioeconomic status. Fewer studies examined provider knowledge of sequalae, yet these studies identified multiple misconceptions regarding appropriate screening practices for microvascular complications and the need to screen patients who are asymptomatic. Further investigations are needed that use well validated measures, control for confounding, and include diverse populations. Such studies will allow identification of patients and providers who would benefit from interventions to improve knowledge of microvascular complications and, ultimately, improve patient outcomes.

Patient-perceived and practitioner-perceived barriers to accessing foot care services for people with diabetes mellitus: a systematic literature review

BACKGROUND

Foot-related complications are common in people with diabetes mellitus, however foot care services are underutilized by this population. This research aimed to systematically review the literature to identify patient and practitioner-perceived barriers to accessing foot care services for people with diabetes.

METHODS

PRISMA guidelines were used to inform the data collection and extraction methods. CINAHL, MEDLINE, and Scopus databases were searched in March 2022 to identify original research articles that reported on barriers to accessing diabetes foot care services from the patient and/or practitioner perspective. Both quantitative and qualitative studies were included. The methodological quality of included studies was assessed using the Critical Appraisal Skills Program (CASP) tool for qualitative/mixed methods studies or the National Heart, Lung & Blood Institute (NHLBI) tool for quantitative studies. Following data extraction, content analysis was used to identify reported barriers. Themes and subthemes were presented separately for patient-perspectives and practitioner-perspectives. A narrative summary was used to synthesize the findings from the included studies.

RESULTS

A total of 20 studies were included. The majority of CASP and NHLBI criteria were met by most studies, indicating good overall methodological quality. Three predominant themes emerged from the patient perspective that represented barriers to accessing foot care services: lack of understanding, socioeconomic factors, and lack of service availability. Four themes emerged from the practitioner perspective: poor interprofessional communication, lack of resources, lack of practitioner knowledge, and perceived patient factors.

CONCLUSIONS

This study has identified a number of barriers to accessing foot care services from both the patient and practitioner perspectives. Although patients focused predominantly on patient-level factors, while practitioners focused on barriers related to the health care system, there was some overlap between them. This emphasizes the importance of recognising both perspectives for the future integration of policy changes and access facilitators that may help to overcome these barriers.

Survey research in podiatric medicine: An analysis of the reporting of response rates and non-response bias

BACKGROUND

Survey research is common practice in podiatry literature and many other health-related fields. An important component of the reporting of survey results is the provision of sufficient information to permit readers to understand the validity and representativeness of the results presented. However, the quality of survey reporting measures in the body of podiatry literature has not been systematically reviewed.

OBJECTIVE

To examine the reporting of response rates and nonresponse bias within survey research articles published in the podiatric literature in order to provide a foundation with regard to the development of appropriate research reporting standards within the profession.

METHODS

This study reports on a secondary analysis of survey research published in the Journal of the American Podiatric Medical Association, the Foot, and the Journal of Foot and Ankle Research. 98 surveys published from 2000 to 2018 were reviewed and data abstracted regarding the report of response rates and non-response bias.

RESULTS

67 surveys (68.4%) report a response rate while only 36 articles (36.7%) mention non-response bias in any capacity.

CONCLUSIONS

The findings suggest that there is room for improvement in the quality of reporting response rates and nonresponse in the body of podiatric literature involving survey research. Both nonresponse and response rate should be reported to assess survey quality. This is particularly problematic for studies that contribute to best practices.

Recurring Wounds in a Diabetic with Multiple Medical Problems: Lower Extremity Wound Care

Acute trauma leading to open wounds in the lower extremity of a patient with diabetes mellitus can be life threatening. Diabetes mellitus complicates and compromises wound care and tissue repair for several reasons. This case report describes the successful wound care treatment modalities used in the care of a 53-year-old male who presented with diabetes and a full-thickness lower leg wound.

Forecasting the Value of Podiatric Medical Care in Newly Insured Diabetic Patients During Implementation of the Affordable Care Act in California

BACKGROUND

Because value-based care is critical to the Affordable Care Act success, we forecasted inpatient costs and the potential impact of podiatric medical care on savings in the diabetic population through improved care quality and decreased resource use during implementation of the health reform initiatives in California.

METHODS

We forecasted enrollment of diabetic adults into Medicaid and subsidized health benefit exchange programs using the California Simulation of Insurance Markets (CalSIM) base model. Amputations and admissions per 1,000 diabetic patients and inpatient costs were based on the California Office of Statewide Health Planning and Development 2009-2011 inpatient discharge files. We evaluated cost in three categories: uncomplicated admissions, amputations during admissions, and discharges to a skilled nursing facility. Total costs and projected savings were calculated by applying the metrics and cost to the projected enrollment.

RESULTS

Diabetic patients accounted for 6.6% of those newly eligible for Medicaid or health benefit exchange subsidies, with a 60.8% take-up rate. We project costs to be $24.2 million in the diabetic take-up population from 2014 to 2019. Inpatient costs were 94.3% higher when amputations occurred during the admission and 46.7% higher when discharged to a skilled nursing facility. Meanwhile, 61.0% of costs were attributed to uncomplicated admissions. Podiatric medical services saved 4.1% with a 10% reduction in admissions and amputations and an additional 1% for every 10% improvement in access to podiatric medical care.

CONCLUSIONS

When implementing the Affordable Care Act, inclusion of podiatric medical services on multidisciplinary teams and in chronic-care models featuring prevention helps shift care to ambulatory settings to realize the greatest cost savings.

The system of care for the diabetic foot: objectives, outcomes, and opportunities

Most cases of lower extremity limb loss in the United States occur among people with diabetes who have a diabetic foot ulcer (DFU). These DFUs and the associated limb loss that may occur lead to excess healthcare costs and have a large negative impact on mobility, psychosocial well-being, and quality of life. The strategies for DFU prevention and management are evolving, but the implementation of these prevention and management strategies remains challenging. Barriers to implementation include poor access to primary medical care; patient beliefs and lack of adherence to medical advice; delays in DFU recognition; limited healthcare resources and practice heterogeneity of specialists. Herein, we review the contemporary outcomes of DFU prevention and management to provide a framework for prioritizing quality improvement efforts within a resource-limited healthcare environment.

Predictors of podiatry utilisation in Australia: the North West Adelaide Health Study

BACKGROUND

Foot problems are highly prevalent in the community; however no large population-based studies have examined the characteristics of those who do and do not access podiatry services in Australia. The aim of this study was to explore patterns of podiatry utilisation in a population-based sample of people aged 18 years and over living in the northwest region of Adelaide, South Australia.

METHODS

The North West Adelaide Health Study is a representative longitudinal cohort study of 4,060 people randomly selected and recruited by telephone interview. The interview included questions regarding healthcare service utilisation in the past year. Data were also collected on education, income and major medical conditions.

RESULTS

Overall, 9.5% of the total sample and 17.7% of those who reported foot pain had attended a podiatrist in the past year. Participants who had accessed podiatry treatment were more likely to be female, be aged over 45 years, be obese, and have major chronic medical conditions (osteoporosis, osteoarthritis, diabetes, cardiovascular disease and high blood pressure). Those who reported foot pain but had not accessed a podiatrist were more likely to be male and be aged 20 to 34 years.

CONCLUSION

Only a small proportion of people who report foot pain have accessed podiatry services in the past year. There is a need to further promote podiatry services to the general community, particularly to men and younger people.