Normahani Pasha, Mustafa Chira, Standfield Nigel J, Duguid Claire, Fox Martin, Jaffer Usman
1Department of Vascular Surgery, Imperial College NHS Healthcare Trust, London, UK.
5Department of Vascular Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK.
J Foot Ankle Res. 2018 Jun 8;11:29. doi: 10.1186/s13047-018-0270-5. eCollection 2018.
We aimed to investigate podiatry practice in diagnosing peripheral arterial disease (PAD) in diabetes, decision making once PAD is suspected and limitations of referral pathways.
A survey, comprising 26 questions was distributed to podiatrists across the UK via mailing lists of collaborating organizations including the College of Podiatry (UK). Response rates were estimated based on NHS workforce data. Analysis of responses from the open-ended questions was performed using inductive content analysis.
Data from 283 respondents were analyzed. Response rate for all NHS podiatrists across the UK was estimated to be 6%. For the detection of arterial disease only 18.8% ( = 49/260) of participants reported using a full combination of history, pulse palpation, Doppler and ABPI assessment. Self-reported confidence in detecting arterial disease was highest amongst podiatrists who felt they had received adequate training compared to podiatrists who felt they had not (median 85 (IQR 75-90) vs 67 (50-77), respectively; < 0.001) as well as those who see > 20 diabetic patients per week compared to those who see < 20 (median 80 (IQR 70-90) vs 72 (60-82.8), respectively; < 0.001). Over one third of respondents (35.8%, = 93/260) were aware of missed cases of PAD in the past year and 17.5% ( = 38/217) believed that this resulted in an amputation in some cases.The survey highlighted a lack of clarity amongst podiatrists regarding referral guidelines. Additionally, 69% ( = 169/242) reported that their patients had to wait longer than 2-weeks for specialist vascular assessment and 67.6% ( = 54/80) reported similar waits for a Duplex Ultrasound scan. There was a statistically significant variation in DUS waiting time across the UK (X (10, = 80) = 21.59, = 0.017). Inability to make a direct referral to vascular services and long delays were reported as major limitations of the referral pathway.
We have identified important targets for further investigation and quality improvement.
我们旨在调查足病医疗在诊断糖尿病患者外周动脉疾病（PAD）方面的实践情况、怀疑患有PAD后的决策过程以及转诊途径的局限性。
通过包括英国足病医学院在内的合作组织的邮件列表，向英国各地的足病医生发放了一份包含26个问题的调查问卷。根据英国国家医疗服务体系（NHS）的劳动力数据估算回复率。使用归纳性内容分析法对开放式问题的回复进行分析。
对283名受访者的数据进行了分析。据估计，全英国所有NHS足病医生的回复率为6%。在检测动脉疾病方面，只有18.8%（n = 49/260）的参与者报告使用了病史、脉搏触诊、多普勒和踝臂指数（ABPI）评估的完整组合。与认为自己未接受充分培训的足病医生相比，认为自己接受了充分培训的足病医生自我报告的动脉疾病检测信心更高（中位数分别为85（四分位间距75 - 90）和67（50 - 77）；P < 0.001），与每周看诊糖尿病患者少于20例的足病医生相比，每周看诊超过20例糖尿病患者的足病医生自我报告的动脉疾病检测信心更高（中位数分别为80（四分位间距70 - 90）和72（60 - 82.8）；P < 0.001）。超过三分之一的受访者（35.8%，n = 93/260）意识到过去一年中有PAD漏诊病例，17.5%（n = 38/217）认为这在某些情况下导致了截肢。该调查突出了足病医生对转诊指南缺乏清晰认识。此外，69%（n = 169/242）报告称他们的患者等待专科血管评估的时间超过两周，67.6%（n = 54/80）报告称等待双功超声扫描的时间也类似。全英国双功超声扫描等待时间存在统计学上的显著差异（X²（10，n = 80）= 21.59，P = 0.017）。无法直接转诊至血管服务部门以及长时间延误被报告为转诊途径的主要局限性。
我们确定了进一步调查和质量改进的重要目标。
