Multidisciplinary Management of Diabetic Foot Ulcers in Primary Cares in Quebec: Can We Do Better?
Received 25 February 2020
Accepted for publication 27 March 2020
Published 16 April 2020 Volume 2020:13 Pages 381—385
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Magali Brousseau-Foley,1,2 Virginie Blanchette2
1University Family Medicine Group, Faculty of Medicine Affiliated to Université De Montréal, Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada; 2Department of Sciences of Physical Activity and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
Correspondence: Virginie Blanchette
Department of Sciences of Physical Activity and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, Québec G9A 5H7 Tel +1-819-376-5011 Ext. 3756
Abstract: A growing body of evidence supports the presence of integrated foot care based on multidisciplinary and interdisciplinary teams in the management and prevention of diabetic foot ulcer (DFU) worldwide. This model of care is however rare in the clinical setting in Quebec, Canada. Many best practice gaps are identified as well as probable causal hypothesis are listed in this commentary. We support our opinions with a pilot audit conducted as part of a continuous quality improvement process in managing patients with DFU in our area and on Canadian facts and data. Our pilot study (n = 27 hospitalized patients) included a typical DFU population with neuropathy, peripheral arterial disease and previous amputation. It highlights underachievement of best practice recommendations implementation such as multidisciplinary DFU management and offloading interventions in our establishment. Due the high morbidity and mortality associated with DFU patients, four died during the studied hospitalization episode. Several barriers were encountered in the pilot audit justifying that no robust conclusion can be raised. However, our observations are concerning. Even though data accessibility was limited, our observations are sadly coherent with what is found in the literature. Economic data of what this means for our health system is put forward in the overall discussion. We are preoccupied by the trends outlined by some facts and observations, and this commentary was written with this in mind. In the face of the diabetes crisis that is arising, a plea is made to reassess care pathway for this vulnerable population as we emphasize the importance of teamwork in managing DFU.
Keywords: patient care team, teamwork, diabetes complications, foot ulcer, best practice recommendations, guidelines
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