Directorate of Podiatry and Prosthetics & Orthotics, School of Health Sciences, College of health and social care, University of Salford, Frederick Road, Salford M6 6PU, UK.
J Foot Ankle Res. 2014 May 18;7:30. doi: 10.1186/1757-1146-7-30. eCollection 2014.
In this article the authors explore the current issues and barriers related to achieving successful outcomes to diabetic foot complications in India. This was achieved by engaging clinicians in taking ownership of the problems and facilitating them in the identification of solutions to action change in clinical practice.
This was accomplished through facilitating participants in this study via a process of problem identification and planning, the first phases of an action research cycle approach. The methods of data collection were focus groups, observations and individual conversations. The data were analysed using a thematic framework.
Based on the practitioner's experiences and opinions, key themes were identified. These themes had the potential to inform the changes needed in clinical practice, to overcome barriers and embed ownership of the solutions. Five themes were identified highlighting: concerns over a fragmented service; local recognition of need; lack of standardised care pathways; lack of structured assessment and an absence of annual foot screening. Combined, the issues identified were thought to be important in preventing timely assessment and management of foot problems.
It was unanimously agreed that a formalised process of foot assessment should be developed and implemented as part of the subsequent phases of the action research process, which the authors intended to take forward and report in a further paper. The aim of which is to guide triage, education, care pathways, audit and evaluation of outcomes. Facilitation of the clinicians in developing a program and screening tool to implement and teach these skills to others could be an important step in reducing the number of high-risk cases that are often resulting in the amputation of limbs.
本文作者探讨了在印度实现糖尿病足并发症治疗成功所面临的当前问题和障碍。通过让临床医生承担问题的责任，并帮助他们确定临床实践中改变行动的解决方案，从而实现这一目标。
通过为参与本研究的人员提供问题识别和规划的过程，完成了这一目标，这是行动研究循环方法的第一阶段。数据收集的方法是焦点小组、观察和个人对话。使用主题框架对数据进行分析。
根据从业者的经验和意见，确定了关键主题。这些主题有可能为临床实践所需的变革提供信息，克服障碍并使解决方案得到认可。确定了五个主题，突出了以下问题：对分散服务的担忧；当地对需求的认识；缺乏标准化的护理路径；缺乏结构化的评估和缺乏年度足部筛查。这些问题结合在一起，被认为对及时评估和管理足部问题很重要。
与会者一致认为，应制定并实施足部评估的正式程序，作为行动研究后续阶段的一部分，作者打算在进一步的论文中推进和报告这一程序。其目的是指导分诊、教育、护理路径、审计和评估结果。促进临床医生开发一个程序和筛查工具，以实施和教授这些技能给其他人，可能是减少经常导致肢体截肢的高风险病例数量的重要步骤。
