A call for integrated foot care and amputation prevention pathways for patients with diabetes and peripheral arterial disease across Canada
Leg amputation is a devastating complication of diabetes and peripheral arterial disease (PAD). While most diabetic and many PAD-related amputations are preventable, foot care and amputation prevention efforts remain shockingly disjointed in Canada. Primary prevention efforts are often not supported by clear referral networks when foot wounds, gangrene, or infection arise. Acute care of these complications may also lack the required multidisciplinary input from a range of experts: foot specialists (chiropody/podiatry), wound care nursing, surgeons, physicians, occupational and physical therapists, social workers, and pharmacists. Furthermore, multi-morbidity and social marginalization can hinder compliance with treatment recommendations and sustained secondary prevention.
Evidence-based guidelines exist to inform best practice around screening and the key pillars of evaluation and treatment—wound care, pressure offloading, treatment of infection, assessment, and treatment...
This analysis was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources and CIHI.
This article reports the quantitative part of a mixed methods research project conducted for a doctoral dissertation during winter 2018 at the University of Ottawa.
- Alberta Heath Services. Diabetes foot care clinical pathway July 2017. Available at: https://www.albertahealthservices.ca/scns/Page10321.aspx. Accessed 1 June 2018.
- Botros, M., Kuhnke, J., Embil, J., Goettl, K., Morin, C., Parsons, L., et al. (2017) Best practice recommendations for the prevention and management of diabetic foot ulcers. In: Foundations of best practice for skin and wound management. A supplement of wound care Canada. [cited 2018-05-28]. 68p. Available from https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/895-wc-bpr-prevention-and-management-of-diabetic-foot-ulcers-1573r1e-final/file.
- Canadian Partnership Against Cancer (2015) Approaches to high-risk, resource intensive cancer surgical care in Canada. Available at http://www.longwoods.com/articles/images/high-risk-resource-intensive-cancer-surgical.pdf. Accessed 1 June 2018.
- Hingorani, A., LaMuraglia, G. M., Henke, P., Meissner, M. H., Loretz, L., Zinszer, K. M., et al. (2016). The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg, 63, 3S–21S.CrossRefPubMedGoogle Scholar
- National Institute for Health and Care Excellence. Diabetic foot problems: prevention and management. NICE guideline Published: 26 August 2015. Available at nice.org.uk/guidance/ng19. Accessed 1 June 2018