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Organizational and personal bariers to diabetic foot care

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  #1  
Old 2nd June 2008, 02:07 PM
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Default Organizational and personal bariers to diabetic foot care

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Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study
L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K. Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G. R. Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Urbancic, K. Van Acker, J. Van Baal, F. Van Merode, N.
Diabetic Medicine Volume 25 Issue 6 Page 700-707, June 2008
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Aims To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease.

Methods The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization.

Results Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6–55%). At study entry, 77% of the patients had no or inadequate offloading. During follow-up, casting was used in 35% (0–68%) of the plantar fore- or midfoot ulcers. Predictors of use of casting were male gender, large ulcer size and being employed. Vascular imaging was performed in 56% (14–86%) of patients with severe limb ischaemia; revascularization was performed in 43%. Predictors of use of vascular imaging were the presence of infection and ischaemic rest pain.

Conclusion Treatment of many patients is not in line with current guidelines and there are large differences between countries and centres. Our data suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot disease.
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Old 7th June 2008, 02:28 PM
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Default Re: Organizational and personal bariers to diabetic foot care

The Behavior and Psychological Functioning of People at High Risk of Diabetes-Related Foot Complications
Byron Perrin and Hal Swerissen
The Diabetes Educator 2008 34: 493-500
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Purpose
The purpose of this review was to propose a model that describes the influences on the behavior and psychological functioning of people at risk for diabetes-related foot complications.

Methods
A literature search was conducted in Medline (1950-2005), CINAHL (1982-2005), and PsycInfo (1967-2005) databases and in reference lists of journal articles and relevant books. The search focused on published literature in the English language that was related to concepts such as diabetes-related foot complications, behavior, and psychology.

Results
The literature reviewed was arranged to reflect the reciprocal relationship between the personal, environmental, and behavioral factors of people at risk of diabetes-related foot complications. The model proposed uses the concept of reciprocal determinism to illustrate how these factors interact and influence the development of diabetes-related foot complications.

Conclusion
The concept of reciprocal determinism may be useful when developing further investigation into educational and behavioral interventions in this clinical population.
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Old 18th July 2008, 07:39 AM
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Default Re: Organizational and personal bariers to diabetic foot care

Facility-level variations in patient-reported footcare knowledge sufficiency: implications for diabetes performance measurement.
Rajan M, Pogach L, Tseng CL, Reiber G, Johnston M.
Prim Care Diabetes. 2007 Sep;1(3):147-53.
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AIMS: To evaluate medical center variation in self-reported knowledge of footcare practices by veterans at high risk for lower extremity complications.

METHODS: We utilized a previously validated footcare-specific survey from 772 (44% response rate) veterans with diabetes and high-risk foot conditions at eight Veterans Administration facilities that contained items on knowledge of basic (such as how to inspect feet) and specialized self-foot care practices (such as cutting nails and shaving calluses). Linear regression models were used to evaluate facility-level variation in unadjusted and adjusted education (controlling for age, schooling, general, and foot health).

RESULTS: Participants' average age was 67 years, 94% were male and 34% had 13 years of education. The mean facility basic knowledge score on a four-point ordinal scale was 3.1 (range: 2.9-3.3), where 1=no knowledge and 4=enough knowledge. The specialized knowledge score, using the same scale, was 2.52 (range: 2.2-2.8). There were significant (p<0.005) differences among facilities in both unadjusted and adjusted basic and specialized footcare knowledge.

CONCLUSIONS: Patient self-reported footcare knowledge was suboptimal and significantly varied across medical centers with and without adjustment for foot-risk factors, general health, and demographic factors.
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Old 7th August 2008, 06:49 AM
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Default Re: Organizational and personal bariers to diabetic foot care

Patients' perspectives on foot complications in type 2 diabetes: a qualitative study.
Gale L, Vedhara K, Searle A, Kemple T, Campbell R.
Br J Gen Pract. 2008 Aug;58(553):1-9.
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BACKGROUND: Foot ulceration is a major health problem for people with diabetes. To minimise the risk of ulceration, patients are advised to perform preventive foot self-care. AIM: To explore beliefs about diabetic foot complications and everyday foot self-care practices among people with type 2 diabetes.

DESIGN OF STUDY: Qualitative study using one-to-one interviews. SETTING: A suburban primary care health centre. METHOD: Semi-structured interviews with a purposive sample of adults with type 2 diabetes but with no experience of foot ulceration.

RESULTS: Most participants were unsure of what a foot ulcer is and unaware of the difficulties associated with ulcer healing. Prevention of accidental damage to the skin was not considered a priority, as few participants knew that this is a common cause of foot ulceration. Although it was recognised that lower-limb amputation is more common in people with diabetes, this was perceived to be predominantly caused by poor blood supply to the feet and unrelated to foot ulceration. Therefore, preventive foot care focused on stimulating blood circulation, for example by walking barefoot. Consequently, some of the behaviours participants considered beneficial for foot health could potentially increase the risk of ulceration. In some cases the uptake of advice regarding preventive foot care was hampered because participants found it difficult to communicate with health professionals.

CONCLUSION: Patients with type 2 diabetes may have beliefs about foot complications that differ from medical evidence. Such illness beliefs may play a role in foot-related behaviours that have previously been unrecognised. Health professionals need to explore and address the beliefs underlying patients' foot self-care practices.
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Old 13th August 2008, 03:17 PM
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Default Re: Organizational and personal bariers to diabetic foot care

Do Patients' Beliefs about Type 2 Diabetes Differ in Accordance with Complications: An Investigation into Diabetic Foot Ulceration and Retinopathy.
Searle A, Wetherell MA, Campbell R, Dayan C, Weinman J, Vedhara K.
Int J Behav Med. 2008;15(3):173-9.
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Background: Previous research has examined patients' beliefs in diabetes and how these beliefs may affect patient outcomes. However, changes in symptoms and complications are a common feature of diabetes, and these can significantly alter the patient's "disease experience." However, no consideration has been given to how beliefs about diabetes vary according to the complications patients have.

Purpose: The present study was designed to compare the beliefs of 22 patients with diabetic foot ulcers and 22 age-and gender-matched patients with diabetic retinopathy, and 22 age-and gender-matched controls with type 2 diabetes but without either complication. Methods: Beliefs about diabetes were assessed with the Revised Illness Perception Questionnaire (IPQ-R; Moss-Morris et al., 2002).

Results: Patients with foot ulcers held a greater belief in personal control of diabetes, but perceived treatment control was lower than that of diabetic controls without serious complications (p < .05). Patients with foot ulcers also demonstrated less illness coherence than patients with retinopathy and diabetic controls (p < .01) and also perceived their diabetes to be more cyclical in nature (p < .01).

Conclusion. Differences were found in diabetic patients' beliefs according to their complications. Future interventions should consider how the complications associated with diabetes may affect patients' beliefs and subsequent emotional and behavioral responses to the disease.
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  #6  
Old 18th November 2008, 02:38 PM
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Default Re: Organizational and personal bariers to diabetic foot care

Diabetes foot self-care practices in the German population.
Schmidt S, Mayer H, Panfil EM.
J Clin Nurs. 2008 Nov;17(21):2920-2926.
Quote:
Aim. The object of this study was to find out which self-care activities patients with diabetes perform to prevent diabetic foot syndrome (DFS) and to look for differences between patient groups (diabetes education and foot at risk).

Background. Besides the importance of screening patients at risk to develop a DFS and the clinical interventions, it is also necessary to involve the patient with diabetes in the self-care of their feet. There is no information in Germany concerning self-care activities carried out by patients for the prevention of DFS.

Design. A cross-sectional study. Method. A secondary analysis of the data used in the study for the development of the 'Frankfurter Catalogue of Foot Self-Care - Prevention of Diabetic Foot Syndrome'. Two hundred and sixty-nine patients with type 1 and type 2 diabetes were included. The study population was divided into different training experience groups and foot at risk groups based on self-reported data.

Results. Patients who had participated in more than three education programmes performed significantly better self-care than patients who had no or only one training programme. Patients with a foot at risk for the development of diabetic foot ulcer perform more adequate self-care regarding professional assistance in foot care, but are not more active in the self-control of the feet, shoes and socks.

Conclusions. There are self-care deficits regarding self-control of feet, shoes and socks. Based on the data it seems to be that more than three education programmes are needed to lead to performance of adequate self-care. Especially patients with a foot at risk need more professional support for their daily self-care activities to prevent DFS or further foot complications.

Relevance to clinical practice. The first findings support that it might be helpful to identify patients with self-care deficits and therefore to improve patients daily foot self-care.
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Old 26th November 2009, 02:22 PM
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Default Re: Organizational and personal bariers to diabetic foot care

Foot care education and self management behaviors in diverse veterans with diabetes.
Olson JM, Hogan MT, Pogach LM, Rajan M, Raugi GJ, Reiber GE.
Patient Prefer Adherence. 2009 Nov 3;3:45-50.
Quote:
The objective of this study was to examine differences in self-reported diabetes foot care education, self management behaviors, and barriers to good foot care among veterans with diabetes by race and ethnicity. Data was collected using the Veterans Health Administration Footcare Survey, a validated tool that assessed demographic, general health, diabetes and foot self-care information, barriers to foot self-care, receipt of professional foot care, and satisfaction with current care. We mailed surveys to a random sample of patients with diabetes from eight VA medical centers. Study participants were 81% White; 13% African American; 4% Asian, and 2% American Indian and Pacific Islanders. The majority of respondents felt that they did not know enough about foot self-care. There were large gaps between self-reported knowledge and actual foot care practices, even among those who reported "knowing enough" on a given topic. There were significant differences in self-reported foot care behaviors and education by race and ethnicity. These findings document the need for culturally-specific self-management education to address unique cultural preferences and barriers to care.
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Old 26th February 2010, 02:32 PM
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Default Re: Organizational and personal bariers to diabetic foot care

Perceived Risk of Amputation, Emotions, and Foot Self-care Among Adults With Type 2 Diabetes.
Scollan-Koliopoulos M, Walker EA, Bleich D.
Diabetes Educ. 2010 Feb 24. [Epub ahead of print]
Quote:
Purpose The purpose of this study was to determine the influence of having a family member who experienced an amputation on one's own perceived risk and fear of experiencing a diabetes-related amputation.

Methods This was a descriptive cross-sectional study using paper-and-pencil surveys by mail. Adults with type 2 diabetes and a family history of diabetes attending a self-management education program in the Metropolitan New York/New Jersey area were recruited. Measures were completed about risk perception and fear of amputation, emotional representations of diabetes from the Illness Perception Questionnaire, and the foot self-care behavior component of the Summary of Diabetes Self-care Activities Survey. The authors estimated the variability in foot self-care that was accounted for by risk perception and fearful memories.

Results In those who remembered a family member needing an amputation, high perceived risk and fear was associated with less routine foot self-care. For those without family history of amputation, fear was positively associated with foot self-care.

Conclusions Motivation for foot self-care behavior may be driven by risk perception and emotional responses. The ways in which risk perception and fear influence motivation for preventive foot self-care behavior are influenced by whether one's family member was affected by an amputation. Probing about the influence of the patient's legacy of diabetes may be helpful when customizing education plans.
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Old 1st August 2010, 03:44 PM
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Default Re: Organizational and personal bariers to diabetic foot care

Depression and Incident Diabetic Foot Ulcers: A Prospective Cohort Study.
Williams LH, Rutter CM, Katon WJ, Reiber GE, Ciechanowski P, Heckbert SR, Lin EH, Ludman EJ, Oliver MM, Young BA, Von Korff M.
Am J Med. 2010 Aug;123(8):748-754.e3.
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OBJECTIVE: To test whether depression is associated with an increased risk of incident diabetic foot ulcers.

METHODS: The Pathways Epidemiologic Study is a population-based prospective cohort study of 4839 patients with diabetes in 2000-2007. The present analysis included 3474 adults with type 2 diabetes and no prior diabetic foot ulcers or amputations. Mean follow-up was 4.1 years. Major and minor depression assessed by the Patient Health Questionnaire-9 were the exposures of interest. The outcome of interest was incident diabetic foot ulcers. We computed the hazard ratio and 95% confidence interval (CI) for incident diabetic foot ulcers, comparing patients with major and minor depression with those without depression and adjusting for sociodemographic characteristics, medical comorbidity, glycosylated hemoglobin, diabetes duration, insulin use, number of diabetes complications, body mass index, smoking status, and foot self-care. Sensitivity analyses also adjusted for peripheral neuropathy and peripheral arterial disease as defined by diagnosis codes.

RESULTS: Compared with patients without depression, patients with major depression by Patient Health Questionnaire-9 had a 2-fold increase in the risk of incident diabetic foot ulcers (adjusted hazard ratio 2.00; 95% CI, 1.24-3.25). There was no statistically significant association between minor depression by Patient Health Questionnaire-9 and incident diabetic foot ulcers (adjusted hazard ratio 1.37; 95% CI, 0.77-2.44).

CONCLUSION: Major depression by Patient Health Questionnaire-9 is associated with a 2-fold higher risk of incident diabetic foot ulcers. Future studies of this association should include better measures of peripheral neuropathy and peripheral arterial disease, which are possible confounders or mediators
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Old 16th August 2011, 04:33 AM
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Default Re: Organizational and personal bariers to diabetic foot care

Factors influencing the awareness of diabetic foot risks.
Lamchahab FZ, El Kihal N, Khoudri I, Chraibi A, Hassam B, Ait Ourhroui M.
Ann Phys Rehabil Med. 2011 Aug 2.
Quote:
INTRODUCTION:
The aim of the present study was to identify factors influencing diabetic patients' awareness of the risk of foot problems.

METHODS:
We performed a prospective study of diabetic patients hospitalized or seen in consultation. Various factors were analyzed in order to identify those related to the patients' level of awareness of risk factors in diabetic foot.

RESULTS:
Ninety-one patients were included (mean age: 48; male/female gender ratio: 0.63). Over 50% of the study population was not aware of the risks of diabetic foot. Educational level and socioeconomic status had an impact on awareness of good foot health and care. Poor knowledge of the degenerative complications of diabetes was associated with age, a low educational level and low socioeconomic status.

DISCUSSION:
Our results revealed low levels of patient awareness concerning the potential severity of diabetic foot and the means of preventing foot problems. The patients gave a range of explanations for this marked lack of awareness; including a lack of information and financial constraints. Hence, patient education is still a major aspect of prevention in diabetes.

CONCLUSION:
In diabetes, there is still a need for easily assimilated, locally provided patient education.
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Old 30th August 2011, 11:50 AM
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Default Re: Organizational and personal bariers to diabetic foot care

A national approach to diabetes foot risk stratification and foot care.
Leese GP, Stang D, Pearson DW; on behalf of the Scottish Diabetes Foot Action Group.
Scott Med J. 2011 Aug;56(3):151-155.
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The Scottish Diabetes Foot Action Group (SDG) has developed and introduced a national strategy plan for diabetic foot care across Scotland. This has involved the implementation of an evidence-based national foot screening and risk stratification programme that has already covered 61% of the population in just the first two years. Nationally agreed patient information foot leaflets and professional education material have been introduced, and a consensus for antibiotic use in the diabetic foot has been published. Information on multidisciplinary specialist foot services has been collected, indicating that 58% of Health Board areas have consultants with dedicated sessions in their job plan to a foot clinic, and 42% had integrated orthotic involvement. The SDG aims to increase these figures. Work has been undertaken to support local podiatry networks and improve communication between the specialist centre and the community. At a national level the SDG is working with Foot in Diabetes UK (FDUK) to recognize key podiatry skills by developing core competencies and a competency framework for the diabetes podiatrist and diabetes orthotist. The annual Scottish Diabetes Survey indicates some improvement in amputation rates with prevalence decreasing from 0.8% to 0.5%, and improved recording of foot ulceration at a national level. This national strategy has helped highlight the importance and difficulties facing diabetes foot care and should help to continue to improve the quality of care of people with diabetes who have foot-related
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