文章基本信息

标题：A pilot program of integration of preventive foot care into comprehensive care of diabetic hemodialysis patients
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作者：Nuno Moreira Fonseca ; Rui Barata ; Ana Gaspar 等
期刊名称：International Journal of Integrated Care
电子版ISSN：1568-4156
出版年度：2019
卷号：19
期号：4
页码：1-2
DOI：10.5334/ijic.s3174
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Diabetes mellitus is a common endocrine disorder known for its multifaceted complications, including diabetic foot ulcers which often result in amputation. Foot ulcer disease poses a therapeutic challenge as concomitant infection is frequently present, making it a leading cause of diabetes-related hospital admission. Renal patients on hemodialysis often present advanced peripheral artery disease, which also increases the risk of foot ulcer disease. Our hemodialysis clinic provides renal care exclusively to diabetic patients. While most hemodialysis centers provide comprehensive care to renal patients that extends beyond hemodialytic treatment, such as nutritional guidance or social support, dedicated care to address foot care is generally lacking. Our patients complex health needs often require visits to multiple providers, which can be challenging for patients in the absence of coordinated care. Given the particularly dire impact of diabetic ulcer disease on patients’ morbidity and quality of life, we have decided to improve patients’ care coordination by implementing a preventive foot care program at our hemodialysis clinic. Our pilot program will be based in two simultaneous approaches: Patients, families and caretakers, will be provided with inhouse educational sessions on foot care and preventive strategies for ulcerative disease. In addition to patient empowerment, monthly active surveillance of ulcerative disease will be provided in cooperation with an external podology clinic dedicated to diabetic patients. Outcomes will be measured by incidence of foot ulcers, antibiotic use, amputations, hospitalizations, and related mortality. All patients currently undergoing hemodialysis at our clinic (n=50) will be included. This program will be carried out by our hemodialysis clinical team jointly with a podology clinic specialized in diabetic foot care. Educational one-hour sessions on ‘preventive foot care’ will be provided to patients and family or caretakers in smalls groups of 8-10 people. Patients will be actively assessed on a monthly basis at the podology clinic. Our joint podology-nephrology program is a commitment to the delivery of person-centered, high-quality care that aims to improve health outcomes, by reducing the incidence of underlying disease complications, hospital admission, as well as a mortality.
关键词：patient empowerment ; care integration ; nephrology ; foot care