Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.
Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.
Diabetes Res Clin Pract. 2019 Mar;149:126-131. doi: 10.1016/j.diabres.2019.02.003. Epub 2019 Feb 7.
To investigate at a national level the multidisciplinary team (MDT) care of patients with diabetes mellitus and foot complications.
A questionnaire was sent to all 75 Swedish hospitals with emergency departments, which were grouped according to size.
The response rate was 92%, 58/69 of the hospitals have a foot team. Most teams have access to an internal medicine specialist/diabetologist, podiatrist and orthotist. Fewer teams reported access to an orthopaedic surgeon and infectious diseases specialist and only half to a vascular surgeon. In joint MDT outpatient evaluations, the majority report the presence of an internal medicine specialist, podiatrist and orthotist, but 50% an infectious disease specialist and orthopaedic surgeon and only a few a vascular surgeon. In hospitalized patients, there is a reduction in the presence of all specialists. The registration of amputation rate and healed foot ulcers is low.
MDT care is mostly adopted among large and medium-sized hospitals in contrast to small ones, which could reflect unequal health care. Vascular surgeons seldom are present at MDT evaluations and there is a reduced regular input of specialists in the evaluation of hospitalized patients. The hospitals' ability to evaluate their work by potential quality control markers is poor.
在全国范围内调查糖尿病和足部并发症患者的多学科团队（MDT）护理情况。
向所有 75 家设有急诊部门的瑞典医院发放了问卷，并按规模进行了分组。
应答率为 92%，69 家医院中的 58 家设有足部团队。大多数团队都可以获得内科专家/糖尿病专家、足病医生和矫形师的支持。较少的团队报告能够获得骨科医生和传染病专家的支持，只有一半的团队能够获得血管外科医生的支持。在联合 MDT 门诊评估中，大多数团队报告有内科专家、足病医生和矫形师的参与，但 50%的团队报告有传染病专家和骨科医生的参与，只有少数团队有血管外科医生的参与。在住院患者中，所有专家的参与都有所减少。截肢率和足部溃疡愈合的登记率较低。
MDT 护理主要在大型和中型医院中采用，而小型医院则较少采用，这可能反映了医疗保健的不平等。血管外科医生很少参与 MDT 评估，住院患者的专科医生定期参与评估的情况也有所减少。医院通过潜在的质量控制指标评估其工作的能力较差。
