糖尿病患者行小截肢术后门诊足病服务利用的性质和程度：回顾性临床审计。

Nature and extent of outpatient podiatry service utilisation in people with diabetes undergoing minor foot amputations: a retrospective clinical audit.

机构信息

BE130 Health Precinct, Brush Road, Ourimbah, NSW, 2258, Australia.

Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia.

出版信息

J Foot Ankle Res. 2021 Jan 13;14(1):6. doi: 10.1186/s13047-020-00445-5.

DOI:10.1186/s13047-020-00445-5

PMID:33435997

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7805117/

Abstract

BACKGROUND

People with diabetes are at high risk of foot complications that can lead to lower extremity amputations. National standards suggest that early assessment and management by a podiatry led multidisciplinary high-risk foot clinic (HRFC) helps to reduce complications. This review is a retrospective audit of the Central Coast Local Health District (CCLHD) podiatry department service utilisation in people with diabetes who had undergone a minor foot amputation.

METHODS

All people with diabetes who had minor foot amputations in the calendar year 2017 in the CCLHD in New South Wales were identified. Podiatry occasions of service from all podiatry service clinics (e.g. general, orthoses, wound, HRFC) and hospital stays for 12 months prior to, and 12 months, post the minor foot amputation were extracted.

RESULTS

Data on 74 people with diabetes who underwent 85 minor foot amputations were collected. In the 12-month period leading up to their minor foot amputation less than half, 42% (n=31), of the patients had attended any of the available podiatry service clinics within the CCLHD system. Post-amputation and discharge from hospital there was an overall rise of 26% in numbers attending all CCLHD podiatry- led clinics bringing the total to 68% (51). However, attendance at the HRFC rose by only 2% from 16% (n=12) to 18% n= (13).

CONCLUSION

This study shows that there was underutilisation of Podiatry Services in the CCLHD in 2017 with some participants not meeting national treatment guidelines for foot health services. Revision of current referral pathways both prior to, during and following hospitalisation and expanding the multidisciplinary HRFC to accommodate the population by providing more accessible locations has since been undertaken to increase service access. Further provision of education to those highlighted to be at high risk has also been implemented.

摘要

背景

糖尿病患者足部并发症风险较高，可能导致下肢截肢。国家标准建议，由足病学主导的多学科高危足部诊所（HRFC）进行早期评估和管理，有助于减少并发症。本研究对新南威尔士州中央海岸地方卫生区（CCLHD）足部疾病部门服务利用情况进行了回顾性审计，评估对象为接受小截肢手术的糖尿病患者。

方法

在新南威尔士州中央海岸地方卫生区，确定了 2017 年所有接受小截肢手术的糖尿病患者。提取了所有足部疾病服务诊所（如普通诊所、矫形器诊所、伤口诊所、HRFC）的足部疾病就诊记录，以及小截肢术前 12 个月和术后 12 个月的住院记录。

结果

共收集了 74 名接受 85 次小截肢手术的糖尿病患者的数据。在小截肢术前的 12 个月内，不到一半（42%，n=31）的患者在 CCLHD 系统内的任何一家足部疾病服务诊所就诊。截肢和出院后，所有 CCLHD 足部疾病主导诊所的就诊人数总体增加了 26%，达到 68%（n=51）。然而，HRFC 的就诊人数仅增加了 2%，从 16%（n=12）增加到 18%（n=13）。

结论

本研究表明，2017 年 CCLHD 的足部疾病服务利用不足，部分参与者未满足国家足部健康服务治疗指南。此后，对现行转诊途径进行了修订，包括在住院前、住院期间和出院后，并扩大了多学科 HRFC 的规模，以通过提供更多便捷的地点来为更多人群提供服务。此后，还对高危人群进行了更多的教育，并实施了进一步的服务提供。