Perspectives on current provision of Acute Diabetic Foot Care

Abstract

Aim
Up to 34% of diabetic patients will develop diabetic foot ulcers (DFUs) over their lifetime, with significant associated morbidity, mortality, and healthcare costs. Timely access to a multidisciplinary foot team (MDFT) can reduce DFU complications and represents the gold standard of management. Despite this, MDFT in Ireland is perceived to be ad hoc. This short report presents feedback from Irish healthcare professionals working on the frontline of diabetic foot disease.

Methods
An opportunistic electronic mixed-method surveys was sent to all attendees of the Beaumont Multidisciplinary Diabetic Foot Care Symposium, a cross-speciality meeting of stakeholders in diabetic foot care across hospital and community settings in Ireland. A series of categorial and Likert scale questions were designed to gather current perspectives on service design and delivery. A thematic analysis was performed on free-text responses.

Results
The response rate was 84/160 (52%), including 35 podiatrists (42%), 30 doctors (36%), 14 nurses (17%) and 3 orthotists (3.5%). Based on meeting content, 79/84 (94%) of responders reported they found the meeting “relevant or very relevant” to their current practice and 60/84 (71%) reported they were “likely or very likely” to change their practice. 73/77 (95%) of responders were in favour of a designated “Diabetic Foot Coordinator” to bridge community and hospital care. A thematic analysis of free-text “key take-aways” identified the importance of a formalised multidisciplinary DFU service with “buy-in” from all specialties as the most common response (58 [69%]).

Discussion
Regular multidisciplinary meetings can showcase gold-standard care, update on current developments towards MDFT in Ireland and facilitate networking between specialties. However, institutional support, ring-fenced funding and realistic key performance indicators are needed to advance Irish diabetic foot care in line with international best practice.