Importance of interprofessional collaboration in teaching diabetic foot self-management: Perceptions of health care professionals

Background

Diabetes and associated diabetic foot ulcers require coordinated management, including several health care professional (HCPs). Therefore, an interprofessional (IP) team-based approach is essential for effectively managing and educating the population on diabetic foot self-management strategies. However, the perceptions of the HCPs related to the importance of IP teamwork in diabetic foot care and their readiness to work in an IP team are less explored.

Methods

This qualitative study aimed to investigate the HCPs' perception on the importance of IP collaboration in diabetic foot care and their readiness to work as part of an IP team in teaching patients' effective diabetic foot self-management techniques. The study includes seven HCPs involved in diabetic foot management patient education and treatment. In-depth interviews using an interview guide and a thematic analysis of the interview transcripts were undertaken.

Results

Every participant was strongly motivated to be an IP team member. The following themes were identified that supported IP team-based approach in diabetic foot care: 'patient-centric practices,' 'comprehensive care,' 'teamwork and coordination for improved patient outcome,' 'integrated approach,' 'professional knowledge amalgamation,' 'time-management,' 'education in a favorable environment,' 'constant motivation and support through educational modules,' and 'commitment and policy reforms.'

Conclusions

The HCPs' were aware about the benefits of IP team-based approach in diabetic foot care. They further expressed their willingness to work as part of an IP team and suggested appropriate teaching methods for diabetic foot self-management. This manuscript thus attempts to create an awareness about the importance of IP approach in teaching the proper practices of diabetic foot care. The problems faced in implementing an IP approach in diabetic foot care and the possible solutions are also discussed.

Upskilling programmes for unregulated care providers to provide diabetic foot screening for systematically marginalised populations: how, why and in what contexts do they work? A realist review

OBJECTIVE

We aimed to understand how, why and in what context upskilling programmes for unregulated care providers (UCPs) to provide foot screening for systematically marginalised groups living with diabetes were implemented.

DESIGN

We used realist synthesis based on Realist And Meta-narrative Evidence Syntheses: Evolving Standards guidance.

DATA SOURCES

We searched the Medline, Embase, PsycINFO, CINAHL, ERIC, Web of Science Core Collection, and Scopus databases and the grey literature (Google Scholar, ProQuest Dissertations and Theses) up to November 2022.

ELIGIBILITY CRITERIA

We included experimental and non-experimental articles in English that either described mechanisms or discussed expected outcomes for educational interventions for patients and family caregivers or healthcare providers, both regulated and unregulated. We also included articles that evaluated the impact of foot care programmes if the UCPs' training was described.

DATA EXTRACTION AND SYNTHESIS

The lead author extracted, annotated and coded uploaded relevant data to identify contexts, mechanisms and outcome configurations using MAXQDA (a qualitative data analysis software). We used deductive and inductive coding to structure the process. Our team members double-reviewed and appraised a random sample of 20% of articles at all stages to ensure consistency.

RESULTS

Our search identified 52 articles. Evidence suggested the necessity of developing upskilling foot screening programmes within the context of preventive care programmes that also provide education in diabetes, and early referrals for appropriate interventions. Multidisciplinary programmes created an ideal context facilitating coordination between UCPs and their regulated counterparts. Engaging patients and community partners, using a competency-based model, and incorporating cultural competencies were determinants of success for these programmes.

CONCLUSION

This review provides a realistic programme theory for the mechanisms used, the context in which these programmes were developed, and the expected outcomes to train UCPs to provide preventive foot care for systematically marginalised populations.

PROSPERO REGISTRATION NUMBER

CRD42022369208.

What is the Lived Experience of the ‘Three Great Pathologies’ of Diabetic Foot Disease? An Interpretative Phenomenological Analysis of the Independent Thinking of Podiatrists in Diabetes Secondary Care

Researching the podiatrists’ lived experience of The Three Great Pathologies may help improve the quality of patient care. The aim of this research using an Interpretative Phenomenological Analysis approach is to report on insights relating to the Three Great Pathologies of diabetic foot disease – infection, ischaemia and amputation. To do this, data was collected from six New Zealand diabetes care Podiatrists. Three superordinate themes resulted with subordinate themes. They are compromised health status, podiatric challenges and best outcomes. The findings are firstly, patient education remains a priority; secondly, there is an unmet need for postgraduate podiatry education; and thirdly, early intervention is a key measure for reducing the influence of the Three Great Pathologies. This study demonstrates that focussing on a group of six specialist podiatrists contributes to new priorities of care for dealing with the Three Great Pathologies of diabetic foot disease.

Interprofessional collaboration and the care and management of type 2 diabetic patients in the Middle East: A systematic review

The World Health Organization has ranked the Middle East (ME) as the second most prevalent region globally for type 2 diabetes. Currently, treatment options initiated by physicians focus mainly on pharmaceuticals; however, lifestyle factors also have a tremendous impact on a patient's wellness or illness. A potential solution to this issue is to use an interprofessional team approach when caring for this patient population. The purpose of this systematic review is to look at the present literature involving the use of an interprofessional team approach to the care and maintenance of people with type 2 diabetes in the ME. A PRISMA flow diagram demonstrates the authors' literature search and screening process. The systematic review includes nine studies with mixed-methodologies performed in the Middle Eastern region in an outpatient or primary care setting, and demonstrates the use of interprofessional collaboration when providing care for type 2 diabetic patients. A meta-analysis was not included due to the heterogeneity of the studies; however, data analysis is discussed and results are demonstrated through an extraction tool developed by the authors based on The Cochrane Collaboration's data collection form. The aim of this review is to construct meaning surrounding the use and effectiveness of this collaborative approach with the adult and geriatric Middle Eastern diabetic patient population. Recommendations include continued support from multiple healthcare professions, involving nurses, pharmacists, dietitians, and physicians to promote holistic and patient-centred-care leading to fewer type 2 diabetes complications and hospital admissions.

The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review

OBJECTIVE

To assess the impact of the multidisciplinary team in the management of the diabetic foot compared with those who did not receive multidisciplinary care.

METHOD

A systematic review of the literature was conducted using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Embase and Cochrane Library. The following search terms were used: diabetic foot, multidisciplinary team, patient care team, multidisciplinary care team. Data were extracted using a bespoke data extraction tool and quality appraisal of the studies was undertaken using the EBL Critical Appraisal checklist. Data analysis was undertaken using RevMan with results presented as odds ratio for dichotomous data, or mean difference for continuous data, all with the associated 95% confidence intervals.

RESULTS

The search identified 19 eligible studies. Severity of amputation, death rates and length of hospital stay of clients receiving multidisciplinary team care were improved when compared with those who did not receive multidisciplinary team care. Ulcer healing and quality of life showed an improvement but not all studies explored these outcomes. Only 7 of the 19 articles appraised were found to be of acceptable quality, questioning the generalisability of the results.

CONCLUSION

From the currently available evidence a positive impact of the multidisciplinary team on diabetic foot outcomes can be seen, but due to the lack of high-quality evidence and substantial heterogeneity in the studies, these results should be interpreted with caution.