Manu Chris, Lacopi Elisabetta, Bouillet Benjamin, Vouillarmet Julien, Ahluwalia Raju, Lüdemann Claas, Garcia-Klepzig José Luis, Meloni Marco, De Buruaga Víctor Rodriguez-Saenz, Sánchez-Ríos Juan Pedro, Edmonds Mike, Apelqvist Jan, Lázaro-Martínez José Luis, Van Acker Kristien
King's College Hospital, Denmark Hill, SE5 9RS London.
University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56126 Pisa.
J Wound Care. 2018 Mar 2;27(3):186-192. doi: 10.12968/jowc.2018.27.3.186.
Diabetic foot ulceration (DFU) has the potential to deteriorate rapidly without prompt assessment and treatment. The aim of this study was to assess the referral patterns for DFU, from primary care to specialised diabetes foot care units.
A two-part, quantitative, online questionnaire was administered to GPs across four countries in Europe: France, the UK, Germany and Spain. The first part entailed a survey of GPs' perceptions of referrals for DFU. The second part of the questionnaire collected data on recently managed DFU cases.
There were 600 questionnaires collected in the first part of the study (150 per country), and 1188 patient cases of DFU management were included in the second part. Up to 95% of patients had type 2 diabetes. Patients' complaints led to diagnosis, on average, 60% of the time, and the diagnosis was an incidental finding during a consultation 13-28% of the time. On average, only 40% of GPs completely agreed that they have clearly identified DFU clinical practitioners working in a hospital facility. In 55-66% of cases, the duration of DFU was unknown or DFU diagnosis was delayed more than three weeks from the onset of the wound. On average, 48% of patients were referred after an unknown duration or more than one month from the onset of DFU.
Despite differences in health-care structures across Europe, delays in referral to specialist foot care teams seems to be a common theme. There is an ongoing need to educate GPs, nurses and patients to be more aware of the risk of DFU, and the need for prompt referral to specialist diabetic foot teams.
糖尿病足溃疡（DFU）若不及时评估和治疗，有迅速恶化的可能。本研究旨在评估从初级保健机构到专业糖尿病足护理单位的DFU转诊模式。
对欧洲四个国家（法国、英国、德国和西班牙）的全科医生进行了一项分为两部分的定量在线问卷调查。第一部分是对全科医生对DFU转诊的看法进行调查。问卷的第二部分收集了最近处理的DFU病例的数据。
研究的第一部分共收集到600份问卷（每个国家150份），第二部分纳入了1188例DFU管理患者病例。高达95%的患者患有2型糖尿病。患者的主诉平均60%的时间导致诊断，13 - 28%的时间诊断是在会诊期间偶然发现的。平均而言，只有40%的全科医生完全同意他们清楚地确定了在医院设施工作的DFU临床医生。在55 - 66%的病例中，DFU的持续时间未知或DFU诊断从伤口出现起延迟超过三周。平均而言，48%的患者在DFU出现后持续时间未知或超过一个月后才被转诊。
尽管欧洲各地的医疗保健结构存在差异，但转诊至专科足部护理团队的延迟似乎是一个共同问题。持续需要对全科医生、护士和患者进行教育，使其更了解DFU的风险，以及及时转诊至专科糖尿病足团队的必要性。
