Schoen Deborah E, Gausia Kaniz, Glance David G, Thompson Sandra C
Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia.
Centre for Software Practice, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia.
J Foot Ankle Res. 2016 Jul 29;9:26. doi: 10.1186/s13047-016-0157-2. eCollection 2016.
This study aimed to determine knowledge of national guidelines for diabetic foot assessment and risk stratification by rural and remote healthcare professionals in Western Australia and their implementation in practice. Assessment of diabetic foot knowledge, availability of equipment and delivery of foot care education in a primary healthcare setting at baseline enabled evaluation of the effectiveness of a diabetic foot education and training program for generalist healthcare professionals.
This study employed a quasi-experimental pre-test/post-test study design. Healthcare practitioners' knowledge, attitudes and practice of diabetic foot assessment, diabetic foot risks, risk stratification, and use of the 2011 National Health and Medical Research Council Guidelines were investigated with an electronic pre-test survey(.) Healthcare professionals then undertook a 3-h education and training workshop before completing the electronic post-test knowledge, attitudes and practice survey. Comparison of pre-test/post-test survey findings was used to assess the change in knowledge, attitudes and intended practice due to the workshops.
Two hundred and forty-six healthcare professionals from two rural and remote health regions of Western Australia participated in training workshops. Monofilaments and diabetes foot care education brochures, particularly brochures for Aboriginal people, were reported as not readily available in rural and remote health services. For most participants (58 %), their post-test knowledge score increased significantly from the pre-test score. Use of the Guidelines in clinical settings was low (19 %). The healthcare professionals' baseline diabetic foot knowledge was adequate to correctly identify the high risk category. However, stratification of the intermediate risk category was poor, even after training.
This study reports the first assessment of Western Australia's rural and remote health professionals' knowledge, attitudes and practices regarding the diabetic foot. It shows that without training, generalists' levels of knowledge concerning the diabetic foot was low and they were unlikely to assess foot risk. The findings from this study in a rural and remote setting cast doubt on the ability of generalist healthcare professionals to stratify risk appropriately, especially for those at intermediate risk, without clinical decision support tools.
本研究旨在确定西澳大利亚农村和偏远地区医疗保健专业人员对糖尿病足评估和风险分层国家指南的了解情况及其在实践中的实施情况。在基线时对初级医疗保健机构中糖尿病足知识、设备可用性以及足部护理教育的提供情况进行评估，有助于评估针对全科医疗保健专业人员的糖尿病足教育和培训项目的有效性。
本研究采用类实验性的前测/后测研究设计。通过电子前测调查问卷，对医疗保健从业者关于糖尿病足评估、糖尿病足风险、风险分层以及对2011年国家卫生与医学研究委员会指南的使用情况的知识、态度和实践进行调查。然后，医疗保健专业人员参加一个3小时的教育和培训工作坊，之后完成电子后测知识、态度和实践调查问卷。通过比较前测/后测调查结果，评估工作坊导致的知识、态度和预期实践的变化。
来自西澳大利亚两个农村和偏远卫生区域的246名医疗保健专业人员参加了培训工作坊。据报告，农村和偏远卫生服务机构中不易获得单丝检查工具和糖尿病足部护理教育手册，尤其是针对原住民的手册。对于大多数参与者（58%）来说，他们的后测知识得分相比前测得分显著提高。临床环境中对指南的使用率较低（19%）。医疗保健专业人员的基线糖尿病足知识足以正确识别高风险类别。然而，即使经过培训，对中度风险类别的分层情况仍然较差。
本研究首次对西澳大利亚农村和偏远地区卫生专业人员关于糖尿病足的知识、态度和实践进行了评估。结果表明，未经培训时，全科医生对糖尿病足的知识水平较低，且不太可能评估足部风险。在农村和偏远地区开展的这项研究结果让人怀疑，在没有临床决策支持工具的情况下，全科医疗保健专业人员能否适当地进行风险分层，尤其是对中度风险者。
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