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Theme: Person-Centred Care
The recently published The NHS Atlas of Variation in Healthcare (DaSilva and Gray 2010) identifies the South West of England as worst in relation to the incidence of major amputations in people with Type 2 diabetes, although this study did not take into account the prevalence of diabetes in a region, the number of specialist centres and the social, ethnic case mix.
Current NICE guidelines on type 2 diabetes on prevention and management of foot problems state that people with high risk of foot ulcers should be seen between every one to three months by a foot protection team. The guidance also suggests that research needs to be carried out to assess the appropriate level and combination of risk factors at which patients should be categorised as at high risk for ulceration and be offered attendance on a protection programme.
A paper by Donohoe et al (2000) suggests that provision of integrated care arrangements for the diabetic foot has a positive impact on primary care staffs' knowledge and patients' attitudes resulting in an increased number of appropriate referrals to acute specialist services. This work suggests that patients who have been identified as at risk or high risk can benefit from additional support but in the longer term no implementation of a structured education package has been followed up.
The existing evidence suggests that the delivery of a structured education and follow up care package is required to educate and support patients and reduce incidence of acute foot complications. A trained member of a foot protection team could deliver this package of care, ideally a podiatrist or health care professional with specific foot health knowledge.
To implement and evaluate a method for identifying patients at risk and provide them with a structured one to one education package that supports patients to perform daily preventive self-care and to encourage behaviours that minimize precipitating factors of foot ulceration.
The structured education package will include:
This implementation project has been developed in partnership with and active involvement of members of the Diabetes UK North Devon Voluntary Group.