McCulloch Louise, Borthwick Alan, Redmond Anthony, Edwards Katherine, Pinedo-Villanueva Rafael, Prieto-Alhambra Daniel, Judge Andrew, Arden Nigel K, Bowen Catherine J
1Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, University Road, Southampton, Hampshire SO17 1BJ UK.
Faculty of Medicine & Health, Leeds Institute of Rheumatic & Musculoskeletal Medicine, Leeds, UK.
J Foot Ankle Res. 2018 Jun 5;11:27. doi: 10.1186/s13047-018-0262-5. eCollection 2018.
Provision of podiatry services, like other therapies in the UK, is an area that lacks guidance by the National Institute for Health and Care Excellence. Many individuals living with arthritis in the UK are not eligible to access NHS podiatry services. The primary aim of this investigation was to understand the views of podiatry clinicians on their experiences of referral, access, provision and treatment for foot problems for patients who have arthritis.
Focus groups were undertaken to explore, in-depth, individual views of podiatrists working in the UK to gain feedback on experiences of barriers and facilitators to referral, access, provision and treatment for foot problems for individuals living with arthritis. A purposive sampling strategy was adopted and two, semi-structured, focus group interviews conducted, involving 12 podiatrists from both NHS and independent sectors. To account for geographical variations one focus group took place in each of 2 predetermined 'zones' of the UK; Yorkshire and Hampshire. Thematic analysis was employed to identify key meanings and report patterns within the data.
The key themes derived from the podiatry clinician focus groups suggest a variety of factors influencing demand for, and burden of, foot pain within the UK. Participants expressed frustration on having a service that accepts and treats patients according to their condition, rather than their complaint. Additionally, concern was conveyed over variations in the understanding of stakeholders' views of what podiatry is and what podiatrists aim to achieve for patients.
Podiatrists interviewed believed that many individuals living with arthritis in the UK are not eligible to access NHS podiatry services and that this may be, in part, due to confusion over what is known about podiatry and access criteria. Essentially, podiatrists interviewed called for a timely renaissance of current systems, to newer models of care that meet the foot care needs of individual patients' circumstances and incorporate national multi-disciplinary guidance. Through this project, we have formulated key recommendations that are directed towards improving what other stakeholders (including GPs, commissioners and users of podiatry services) know about the effectiveness of podiatry and also to futureproof the profession of podiatry.
与英国的其他疗法一样，足病治疗服务领域缺乏英国国家卫生与临床优化研究所的指导。英国许多患有关节炎的人没有资格获得国民保健制度的足病治疗服务。这项调查的主要目的是了解足病治疗临床医生对于关节炎患者足部问题的转诊、就诊、治疗服务及治疗情况的看法。
开展焦点小组讨论，深入探究在英国工作的足病医生的个人观点，以获取关于关节炎患者足部问题转诊、就诊、治疗服务及治疗方面的障碍和促进因素的反馈。采用了目的抽样策略，进行了两次半结构化焦点小组访谈，涉及来自国民保健制度和独立部门的12名足病医生。为了考虑地域差异，在英国预先确定的两个“区域”（约克郡和汉普郡）各进行了一次焦点小组讨论。采用主题分析法来确定关键意义并报告数据中的模式。
从足病治疗临床医生焦点小组得出的关键主题表明，有多种因素影响英国足部疼痛的需求和负担。参与者对现有一项根据患者病情而非其症状来接纳和治疗患者的服务表示不满。此外，对于利益相关者对足病治疗是什么以及足病医生旨在为患者实现什么目标的理解存在差异，也表达了担忧。
接受访谈的足病医生认为，英国许多患有关节炎的人没有资格获得国民保健制度的足病治疗服务，部分原因可能是对足病治疗及就诊标准的认识存在混乱。本质上，接受访谈的足病医生呼吁当前体系及时复兴，转向能满足个体患者足部护理需求并纳入国家多学科指导的新型护理模式。通过这个项目，我们已经制定了关键建议，旨在提高其他利益相关者（包括全科医生、医疗服务专员和足病治疗服务使用者）对足病治疗有效性的认识，同时也为足病治疗行业做好未来保障。
