Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness IV2 3JH, UK.
Highland Health Board, Inverness IV2 3UJ, UK.
Int J Environ Res Public Health. 2018 May 16;15(5):999. doi: 10.3390/ijerph15050999.
People with diabetes are at increased risk of foot ulcers, which, if left untreated, can lead to infection, gangrene, and subsequent amputation. Management by a multidisciplinary diabetes foot team has been shown to reduce amputation rates; however, accessing specialist treatment is made particularly difficult when living in remote and rural locations, such as many individuals cared for within NHS Highland. The RAPID project was made up of two phases: firstly, to evaluate the technical feasibility of a new integrated care pathway using innovative technology, and secondly, to establish process enhancement of the pathway to justify a larger-scale study. Omni-Hub enabled a face-to-face consultation by the community podiatrist to be enhanced by virtual consultation with members of the multidisciplinary foot team, including specialist diabetes podiatrists and a diabetes consultant. The technical feasibility study provided recommended changes focused around adaptations to the equipment used and the best means to gain successful connectivity. The process enhancement study demonstrated positive outcomes in the process with positive effects both in the service received by patients and experiences of healthcare professionals involved. The RAPID project provides evidence and justification for a larger-scale empirical study to test an embedded pathway and technology solution, which will inform policy change and a paradigm shift in the management of foot ulceration in the community.
糖尿病患者患足部溃疡的风险增加，如果不加以治疗，可能会导致感染、坏疽和随后的截肢。多学科糖尿病足团队的管理已被证明可以降低截肢率；然而，当居住在偏远和农村地区时，如 NHS Highland 照顾的许多人，获得专科治疗尤其困难。RAPID 项目由两个阶段组成：首先，评估使用创新技术的新综合护理途径的技术可行性，其次，确定途径的流程增强以证明更大规模研究的合理性。Omni-Hub 使社区足病医生的面对面咨询能够通过与多学科足部团队的成员（包括专业糖尿病足病医生和糖尿病顾问）进行虚拟咨询来增强。技术可行性研究提供了针对设备使用的适应性和获得成功连接的最佳方法的建议变更。流程增强研究证明了流程中的积极成果，对患者获得的服务和参与医疗保健专业人员的体验都产生了积极影响。RAPID 项目为更大规模的实证研究提供了证据和理由，以测试嵌入式途径和技术解决方案，这将为社区足部溃疡管理的政策变革和范式转变提供信息。
