Organizational changes in diabetic foot care practices for patients at low and moderate risk after implementing a comprehensive foot care program in Alberta, Canada

Chan, Catherine B.; Dmytruk, Kathy; Labbie, Michele; O’Connell, Petra

doi:10.1186/s13047-020-00393-0

Journal of Foot and Ankle Research

Table 4 Assessment of Moderate Risk – Characteristics of Sites

From: Organizational changes in diabetic foot care practices for patients at low and moderate risk after implementing a comprehensive foot care program in Alberta, Canada

Have a formalized clinic	2014			2019			P-value
Have a formalized clinic	Yes	No		Yes	No
Zone	N	N	% Yes	N	N	% Yes
North	11	28	28	5	6	45	0.30
Edmonton	11	12	48	11	7	61	0.53
Central	5	12	29	7	4	64	0.12
Calgary	3	1	75	5	10	33	0.26
South	4	8	33	6	2	75	0.17
Federal or provincial	0	1	0	2	0	100	ND
Total	34	62	35	36	29	55	See Table 2
Non-respondents	8			10
Area of practice (more than 1 answer possible)
Primary or family practice	10	9	53	13	7	65	0.52
Outpatient	4	14	22	7	4	64	0.048
Acute care	5	13	28	3	3	50	0.362
Wound clinic	4	11	27	6	0	100	0.004
Homecare, long-term care	8	28	22	9	10	47	0.07
Community care	6	10	38	3	4	43	1.00
Other	5	2	71	4	3	57	1.00
Type of service (more than 1 answer possible)
HRFT	–	–		13	–
Hospital/clinic team	25	–		20	–
Home care	5	–		4	–
See referrals	4	–		2	–
Services provided (more than one answer possible)
Skin & nail abnormalities	N [%]			N [%]
Total number of sites (formalized and unformalized clinics)	96			39
Skin or nail care provided	44 [46]			21 [54]			0.45
Provide list of foot/nail care providers in the community	33 [34]			26 [67]			0.001
Refer to podiatrist or footcare nurse	33 [34]			29 [74]			< 0.001
Refer to HRFT	–			11 [28]			–
None of the above	8 [8]			1 [3]			–
Other	2 [2]			3 [8]			–
Structural deformities (bunions, hammertoes)
Total number of sites	95 [100]			39
Provide education regarding self-management	47 [49]			30 [77]			0.004
Refer to podiatrist or orthopedics	63 [66]			31 [79]			0.007
Other	13 [14]			3 [8]			ND
None of the above	12 [13]			0			ND
Footwear problems
Total number of sites / no answer	96			39
Provide information/education regarding appropriate footwear selection	76 [79]			35 [90]			0.22
Refer to HRFT	–			18 [46]			–
Refer for footwear / orthotics through AADL	50 [52]			20 [51]			1.00
Refer for footwear / orthotics without AADL authorization	26 [27]			14 [36]			0.31
None of the above	7 [7]			1 [3]			ND
Other	20 [21]			4 [10]			ND
Services provided for vascular problems
Total number of sites	96 [100]			39
Perform vascular (lower limb) assessment	62 [65]			36 [92]			0.001
Refer to HRFT	–			19 [49]			–
Refer to GP for assessment	36 [38]			23 [59]*			0.035
Refer to vascular lab for assessment	24 [25]			15 [38]			0.14
Other	13 [14]			4 [10]			ND
If vascular assessment performed, procedures used	Out of 62			Out of 36
ABPI	44 [71]			16 [44]			0.011
PPG (toe pressures)	37 [60]			17 [47]			0.29
ABPI + PPG (gold standard)	32 [52]			14 [39]			0.29
Pedal pulses	38 [61]			34 [94]			< 0.001
Other	4 [6]			5 [14]			ND
Refer to HRFT	–			17 [47]			–
Services provided for loss of sensation / neuropathic pain	Out of 91			Out of 39
Refer to MD/NP for treatment of neuropathic pain	83 [91]			28 [72]**			0.007
Refer to HRFT	–			18 [46]			–
Address neuropathic pain in their clinic	6 [7]			5 [13]			0.30
Other	2 [2]			1 [3]			ND
None	0			2 [5]			ND
Frequency of reassessing patients with moderate risk
1–3 months	15 [16]			8 [21]			0.62
4–6 months	11 [12]			11 [28]			0.039
7–12 months	8 [8]			3 [8]			1.00
No formalized schedule	48 [53]			7 [18]			< 0.001
Other	7 [8]			9 [23]			ND

Statistical analysis used Fisher’s Exact Test
Abbreviations: ABPI Ankle-brachial pressure index, AADL Alberta Aids to Daily Living, GP General practitioner, HRFT High risk foot team, MD Medical doctor, NP Nurse practitioner, PPG Photoplethysmography toe pressure, ND Not done

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ISSN: 1757-1146

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