Hon Kay Y, McMillan Neil, Fitridge Robert A
Discipline of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia.
Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, Australia.
BMC Health Serv Res. 2024 Mar 11;24(1):324. doi: 10.1186/s12913-024-10768-9.
Pacific Island Countries and Territories (PICTs) are known to have high prevalence of Diabetes Mellitus and high incidence of diabetes-related foot disease. Diabetes-related foot disease can lead to lower limb amputation and is associated with poor outcomes, with increased morbidity and mortality. The purpose of this study was to gain a better understanding of diabetes-related foot disease management in selected countries in PICTs and to identify potential barriers in management of diabetes-related foot disease management in the region.
A cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks.
Seven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development.
Despite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.
众所周知，太平洋岛国和领土（PICTs）糖尿病患病率高，糖尿病相关足部疾病发病率也高。糖尿病相关足部疾病可导致下肢截肢，且与不良预后相关，会增加发病率和死亡率。本研究的目的是更好地了解PICTs选定国家中糖尿病相关足部疾病的管理情况，并确定该地区糖尿病相关足部疾病管理中的潜在障碍。
向六个选定的PICTs地区的11家医院发送了横断面调查问卷。该调查问卷旨在概述糖尿病相关足部疾病（12个月内的住院人数和下肢截肢人数），并确定每个机构提供的临床服务。问卷中包含两个开放式问题（自由文本回答），以探讨有助于改善糖尿病相关足部疾病管理和治疗的举措，以及临床医生在糖尿病相关足部疾病管理中遇到的障碍。调查持续了6周。
四个国家的七家医院提供了回复。临床医生仅将与糖尿病相关足部疾病有关的住院人数和截肢人数作为估计值上报。在所调查的医院中，糖尿病相关足部疾病主要由普通内科医生、普通外科医生和/或骨科医生管理，因为该地区没有专科服务。只有一家医院可提供门诊足病治疗。临床医生在糖尿病相关足部疾病管理中面临的障碍的常见主题大致集中在资源可用性、意识和教育以及专业发展方面。
尽管PICTs地区糖尿病相关足部疾病患病率很高，但似乎缺乏有效的多学科足部服务（MDFs）。为改善该地区糖尿病相关足部疾病患者的预后，有必要建立有效的MDFs，并让国际利益相关者参与进来，以教育、指导以及物质资源的形式提供持续支持。
