Background Neuropathy and vasculopathy can lead to costly and debilitating complications in people with diabetes. The purpose of this study was to evaluate, at an organizational level, uptake of practices included in a diabetic foot care clinical pathway and associated resources. This research focused on patients at low and moderate risk in Alberta, Canada between 2014 to 2019. Methods Serial surveys (2014, 2019) of practices related to screening and care of the feet of people with diabetes. Surveys were administered using a combination of targeted and snowball sampling in order to assess the impact of the clinical pathway first implemented in 2015. The pathway focused on screening, assessment and referral of patients from primary care. High-risk foot teams (HRFT) were established at six sites to provide increased access to specialty care. Comparative statistics were performed to assess differences in footcare practices between 2014 and 2019 using two-tailed Fisher’s exact test or Chi-square test. Results Respondents ( n = 104, 2014 and n = 75, 2019) included personnel from primary health care, home care and long-term care, acute and emergency care, specialty clinics, diabetes-specific programs and private contractors. The proportion of primary care and home care/long-term care (HC/LTC) sites providing screening increased significantly ( p < 0.05). A significant increase in the proportion of sites providing assessment for patients designated as moderate risk also increased from 35% (34 out of 96 sites) to 55% (36 out of 65 sites) ( p < 0.05), particularly with respect to vascular assessment, and the proportion of sites reporting appropriate follow-up intervals according to the pathway recommendation was also improved. Conclusion Provision of a clinical pathway for diabetic foot care along with education and resources led to increased screening in primary care and HC/LTC settings in Alberta, Canada. HRFT provided primary healthcare providers with an important option for referral and also provided increased expertise for procedures such as vascular assessment for patients with moderate risk of ulceration. This comprehensive model has the potential to reduce progression of foot problems and overall health services utilization. Further analyses of outcomes such as incident lower limb amputation and long-term cost-effectiveness of pathway implementation are underway.

中文翻译：

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在加拿大艾伯塔省实施全面足部护理计划后，低风险和中度风险患者糖尿病足部护理实践的组织变化

背景 神经病变和血管病变可导致糖尿病患者出现昂贵且使人衰弱的并发症。本研究的目的是在组织层面评估糖尿病足部护理临床路径和相关资源中包含的实践的采用情况。这项研究的重点是 2014 年至 2019 年加拿大艾伯塔省的低风险和中风险患者。方法对糖尿病患者足部筛查和护理相关实践进行系列调查（2014 年、2019 年）。调查采用定向抽样和滚雪球抽样相结合的方式进行，以评估 2015 年首次实施的临床路径的影响。该路径侧重于初级保健患者的筛查、评估和转诊。在六个地点建立了高风险足部小组 (HRFT)，以提供更多获得专业护理的机会。使用双尾费舍尔精确检验或卡方检验进行比较统计，以评估 2014 年至 2019 年足部护理实践的差异。结果 受访者（n = 104，2014 年和 n = 75，2019 年）包括来自初级卫生保健、家庭护理和长期护理、急性和紧急护理、专科诊所、糖尿病特定项目和私人承包商的人员。提供筛查的初级保健和家庭护理/长期护理 (HC/LTC) 机构的比例显着增加 (p < 0.05)。为中度风险患者提供评估的场所比例也显着增加，从 35%（96 个场所中的 34 个）增加到 55%（65 个场所中的 36 个）（p < 0.05），特别是在血管评估方面，并且根据路径建议报告适当随访间隔的站点比例也有所提高。结论 提供糖尿病足部护理临床路径以及教育和资源，导致加拿大艾伯塔省初级保健和 HC/LTC 机构的筛查增加。HRFT 为初级医疗保健提供者提供了一个重要的转诊选择，并为中等溃疡风险患者的血管评估等程序提供了更多的专业知识。这种综合模型有可能减少足部问题的进展和整体卫生服务的利用。对事件下肢截肢和路径实施的长期成本效益等结果的进一步分析正在进行中。