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Improving Preventive Foot Care for Diabetic Patients Participating in Group Education

Pi-Chang Sun, MD ^* , Shyh-Hua Eric Jao, PhD ^*, Hong-Da Lin, MD , Rai-Chi Chan, MD , Chen-Liang Chou, MD  and Shun-Hwa Wei, PhD ^*

^* Department of Physical Therapy and Assistive Technology, National Yang Ming University, Taipei, Taiwan.
Division of Physical Medicine and Rehabilitation, Taipei City Hospital, Taipei, Taiwan.
Division of Endocrinology and Metabolism, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan.

Corresponding author: Shun-Hwa Wei, PhD, Department of Physical Therapy and Assistive Technology, National Yang Ming University, No. 155, Sec. 2, Li-Nung St, Taipei 11221, Taiwan. (E-mail: shunhwa{at}ym.edu.tw)

Abstract

Background: Diabetic foot care has yet to be enhanced in a universal health-care system in which specialized podiatric medical services are unavailable. This baseline assessment surveyed diabetic patients attending group education to improve current foot-care practices.

Methods: Of 302 diabetic patients receiving usual outpatient care, 155 received group patient education on general diabetes-related information, which included foot care and an annual checkup by a diabetes association during the previous 2 years, and 147 did not. Patient foot-care behaviors, physician practice patterns, and patient self-perceived foot risk as cross-checked with the neurologic and vascular assessments were investigated by conducting retrospective medical record reviews and structured interviews.

Results: More than half of the patients in both groups reported inappropriate self-care behaviors (eg, walking barefoot and heating or soaking their feet). The percentages of patients receiving documented examinations and referrals for foot problems were low in both groups and were not significantly different. Among at-risk patients, 56% of the diabetes association group but only 30% of the non–diabetes association group perceived themselves to be at risk for future foot problems (P < .01).

Conclusions: Many diabetic patients were not offered adequate foot-specific information during group lectures, even those with high-risk foot problems. To improve this, combining caregiver and patient education in foot-care practices is important, and systems of networked multidisciplinary professionals are believed to be needed, particularly in delivering customized interventions to at-risk patients based on the initial evaluation. (J Am Podiatr Med Assoc 99(4): 295–300, 2009)