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McElroy IE, Suarez L, Tan TW. The Impact of Mental Health on Patient Outcomes in Peripheral Arterial Disease and Critical Limb Threatening Ischemia and Potential Avenues to Treatment. Ann Vasc Surg 2024:S0890-5096(24)00161-4. [PMID: 38582197 DOI: 10.1016/j.avsg.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 04/08/2024]
Abstract
The physical consequences of peripheral artery disease (PAD) are well established; however, the impact of comorbid mental health disorders such as depression and anxiety are not well understood. The impact of psychological stress is not only associated with worse perioperative morbidity and mortality but also with a physiologic cascade that accelerates plaque formation. Increasing screening to identify and subsequently treat comorbid mental health disorders is an integral next step in improving outcomes in PAD management. Failure to adequately address social and psychological impact on PAD patients will further widen the gap in disparities faced by high-risk and disenfranchised populations. Integration of mental health professionals, addiction specialists, and community navigators into multidisciplinary care teams can bolster support for PAD patients and improve outcomes.
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Affiliation(s)
- Imani E McElroy
- Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Luis Suarez
- Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tze-Woei Tan
- Division of Vascular Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA.
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Xu H, Wu C, Xiang S, Qiu S, Chen Y, Takashi E, Yanagihara K, Xie P. Psychosocial markers of pre-hospital delay in patients with diabetic foot: A cross-sectional survey. Nurs Open 2024; 11:e2088. [PMID: 38268288 PMCID: PMC10803947 DOI: 10.1002/nop2.2088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIM This study aimed to determine the psychosocial markers associated with pre-hospital delay among patients with diabetic foot (DF). DESIGN This study has a cross-sectional design. METHODS The participants completed a questionnaire including pre-hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale-14. Bivariate and multivariate analyses were conducted to explore independent associations with pre-hospital delay. RESULTS Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self-management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes. PATIENT OR PUBLIC CONTRIBUTION This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China.
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Affiliation(s)
- Huiwen Xu
- School of Nursing & Public HealthYangzhou UniversityYangzhouJiangsuChina
- Nagano College of NursingKomaganeNaganoJapan
| | - Chen Wu
- School of Nursing & Public HealthYangzhou UniversityYangzhouJiangsuChina
| | | | - Shuang Qiu
- Yangzhou Hospital of Traditional Chinese MedicineYangzhouJiangsuChina
| | - Yan Chen
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University/Clinical Medical CollegeYangzhou UniversityYangzhouJiangsuChina
| | - En Takashi
- Nagano College of NursingKomaganeNaganoJapan
| | | | - Ping Xie
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University/Clinical Medical CollegeYangzhou UniversityYangzhouJiangsuChina
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Luo Y, Mai L, Liu X, Yang C. Effectiveness of continuous home wound care on patients with diabetic foot ulcers. J Adv Nurs 2023. [PMID: 38156736 DOI: 10.1111/jan.16039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
AIMS To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). DESIGN A non-randomized parallel controlled non-inferiority trial. METHODS Patients with Wagner grade I-III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per-protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self-management behaviour and medical expenses of the two groups. RESULTS Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self-management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. CONCLUSION The continuous home wound care enhanced self-management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. IMPACT This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non-inferiority in ulcer healing, and supported its superiority in improving self-management behaviour and saving medical expenses. REPORTING METHOD We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. PATIENT OR PUBLIC CONTRIBUTION The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self-management behaviours to develop intervention strategies.
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Affiliation(s)
- YiXin Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - LiFang Mai
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - XingZhou Liu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Blanchette V, Todkar S, Brousseau-Foley M, Rheault N, Weisz T, Poitras ME, Paquette JS, Tremblay MC, Costa IG, Dogba MJ, Giguere A, de Mestral C, Légaré F. Collaboration and Partnership in a 5-Level Engagement Framework for Diabetic Foot Ulcer Management: A Patient-oriented Scoping Review. Can J Diabetes 2023; 47:682-694.e17. [PMID: 37437841 DOI: 10.1016/j.jcjd.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The management of diabetic foot ulcers (DFUs) is complex, and patient engagement is essential for DFU healing, but it often comes down to the patient's consultation. Therefore, we sought to document patients' engagement in terms of collaboration and partnership for DFUs in 5 levels (direct care, organizational, policy level, research, and education), as well as strategies for patient engagement using an adapted engagement framework. METHODS We conducted a scoping review of the literature from inception to April 2022 using the Joanna Briggs Institute method and a patient-oriented approach. We also consulted DFU stakeholders to obtain feedback on the findings. The data were extracted using PROGRESS+ factors for an equity lens. The effects of engagement were described using Bodenheimer's quadruple aims for value-based care. RESULTS Of 4,211 potentially eligible records, 15 studies met our eligibility criteria, including 214 patients involved in engagement initiatives. Most studies were recent (9 of 15 since 2020) and involved patient engagement at the direct medical care level (8 of 15). Self-management (7 of 15) was the principal way to clinically engage the patients. None of the studies sought to define the direct influence of patient engagement on health outcomes. CONCLUSIONS Very few studies described patients' characteristics. Engaged patients were typically men from high-income countries, in their 50s, with poorly managed type 2 diabetes. We found little rigorous research of patient engagement at all levels for DFUs. There is an urgent need to improve the reporting of research in this area and to engage a diversity of patients.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada.
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec, affiliated with Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Trois-Rivières, Canada
| | - Nathalie Rheault
- Québec SSA Support Unit, Sherbrooke University, Longueil Campus, Longueuil, Québec, Canada
| | - Tom Weisz
- Patient Partner, Diabetes Action Canada, Toronto General Hospital, Toronto, Ontario, Canada; Patient Partner, Wounds Canada, North York, Ontario, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Sherbrooke University, Saguenay, Québec, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Idevânia G Costa
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada; Canada Research Chair in Shared Decision-Making and Knowledge Translation, Québec, Canada
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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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Palmer KNB, Crocker RM, Marrero DG, Tan TW. A vicious cycle: employment challenges associated with diabetes foot ulcers in an economically marginalized Southwest US sample. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1027578. [PMID: 37124466 PMCID: PMC10140327 DOI: 10.3389/fcdhc.2023.1027578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023]
Abstract
Aim To describe patients' reported employment challenges associated with diabetic foot ulcers (DFUs). Methods Fifteen patients from under-resourced communities in Southern Arizona, with a history of DFUs and/or amputations, were recruited from a tertiary referral center from June 2020 to February 2021. Participants consented to an audio-recorded semi-structured phone interview. Interviews were transcribed and thematically analyzed using the Dedoose data analysis platform. Results Participants shared a common theme around the cyclic challenges of DFU prevention/management and employment. Those employed in manual labor-intensive jobs or jobs requiring them to be on their feet for long durations of time believed working conditions contributed to the development of their DFUs. Patients reported work incapacity due to declines in mobility and the need to offload for DFU management. Many expressed frustration and emotional distress related to these challenges noting that DFUs resulted in lower remuneration as medical expenses increased. Consequently, loss of income and/or medical insurance often hindered participants' ability to manage DFUs and subsequent complications. Conclusion These data illuminate the vicious cycle of DFU and employment challenges that must be addressed through patient-centered prevention strategies. Healthcare providers should consider a person's contextual factors such as employment type to tailor treatment approaches. Employers should establish inclusive policies that support patients with DFUs returning to work through flexible working hours and adapted work tasks as needed. Policymakers can also mitigate employment challenges by implementing social programs that provide resources for employees who are unable to return to work in their former capacity.
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Affiliation(s)
- Kelly N. B. Palmer
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
- *Correspondence: Kelly N.B. Palmer,
| | - Rebecca M. Crocker
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
| | - David G. Marrero
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Tze-Woei Tan
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, United States
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Tan TW, Crocker RM, Palmer KNB, Gomez C, Armstrong DG, Marrero DG. A qualitative study of barriers to care-seeking for diabetic foot ulceration across multiple levels of the healthcare system. J Foot Ankle Res 2022; 15:56. [PMID: 35932076 PMCID: PMC9356391 DOI: 10.1186/s13047-022-00561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The mechanisms for the observed disparities in diabetes-related amputation are poorly understood and could be related to access for diabetic foot ulceration (DFU) care. This qualitative study aimed to understand patients’ personal experiences navigating the healthcare system and the barriers they faced. Methods Fifteen semi-structured interviews were conducted over the phone between June 2020 to February 2021. Participants with DFUs were recruited from a tertiary referral center in Southern Arizona. The interviews were audio-recorded and analyzed according to the NIMHD Research Framework, focusing on the health care system domain. Results Among the 15 participants included in the study, the mean age was 52.4 years (66.7% male), 66.7% was from minority racial groups, and 73.3% was Medicaid or Indian Health Service beneficiaries. Participants frequently reported barriers at various levels of the healthcare system. On the individual level, themes that arose included health literacy and inadequate insurance coverage resulting in financial strain. On the interpersonal level, participants complained of fragmented relationships with providers and experienced challenges in making follow-up appointments. On the community level, participants reported struggles with medical equipment. On the societal level, participants also noted insufficient preventative foot care and education before DFU onset, and many respondents experienced initial misdiagnoses and delays in receiving care. Conclusions Patients with DFUs face significant barriers in accessing medical care at many levels in the healthcare system and beyond. These data highlight opportunities to address the effects of diabetic foot complications and the inequitable burden of inadequately managed diabetic foot care.
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Affiliation(s)
- Tze-Woei Tan
- Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, Tucson, USA. .,Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Ste 4300, Los Angeles, CA, 90033, USA.
| | - Rebecca M Crocker
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
| | - Kelly N B Palmer
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
| | - Chris Gomez
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, Tucson, USA.,Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Ste 4300, Los Angeles, CA, 90033, USA
| | - David G Marrero
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
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