Implementation of a novel mHealth application for the management of people with diabetes and recently healed foot ulceration: A feasibility study.

BACKGROUND

Diabetic foot ulcers (DFUs) cause significant morbidity and mortality. Faster referral to specialist clinics is associated with a reduced risk of severe DFUs. The INTELLIN diabetes management platform is a novel mHealth application for the management of recently healed DFUs and other complications, promoting engagement and expediting self-referral.

METHODS

To determine the acceptability, suitability, and usability of the INTELLIN platform, time until reulceration, site, ischemia, neuropathy, bacterial infection, and depth (SINBAD) score and incidence of self-referral for recurrence were assessed in patients from the Salford Royal NHS Foundation Trust. Patients and clinic staff also assessed platform usability. A Markov cost-utility model was used for the health economics and outcomes research analysis.

RESULTS

197 patients were assessed for eligibility and 15 entered the full analysis set (FAS). Through Week 52, 8/15 patients experienced recurrence, with a mean SINBAD score of 2.1 and mean duration of 2.6 days. Mean time to recurrence was 273.0 days (95% confidence interval 74.0, 484.0). No patients self-referred. Initial qualitative data showed high platform usability. The INTELLIN platform only required a relative reduction in recurrence of 5% versus standard of care (SoC) for an incremental cost effectiveness ratio of £20,000 per quality-adjusted life-year, suggesting potential for significant cost savings upon wider adoption. The barriers to enrollment encountered demonstrate the impact of socioeconomics on mHealth.

CONCLUSIONS

These results suggest that the INTELLIN platform is required to provide only a small reduction in recurrence compared to SoC to be a cost-effective strategy for prevention of recurrent DFUs.