How does the clinical practice of Aotearoa New Zealand podiatrists align with international guidelines for the prevention of diabetes-related foot disease? A cross-sectional survey.

BACKGROUND: Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this study was to determine the alignment of assessment and management used in the prevention of diabetes-related foot disease by NZ podiatrists to the international prevention guideline recommendations. METHODS: A 37-item web-based survey was developed using a 5-point Likert scale (0 = always; 5 = never) based on the International Working Group of the Diabetic Foot (IWGDF) 2019 prevention guidelines and included domains on participant demographics, sector, caseloads, guidelines, screening, management, education, and referral. The survey was distributed to NZ podiatrists through the NZ podiatry association and social media. Participants completing > 50% of items were included. The Mann-Whitney U test was used to examine differences between sector subgroups. RESULTS: Seventy-seven responses (16.3% of the NZ podiatry workforce) were received, of which 52 completed > 50% of items and were included. Of those 52 podiatrists, 73% were from the private sector. Public sector podiatrists reported higher weekly caseloads of patients with diabetes (p = 0.03) and foot ulcers (p < 0.001). The New Zealand Society for the Study of Diabetes (NZSSD) risk stratification pathway and IWGDF guidelines were the two most frequently utilised guidance documents. Participants reported median scores of at least "often" (< 2) for all items in the assessment and management, inspection, examination, and education provision domains for people with a high-risk foot. More than 50% of respondents reported screening more frequently than guideline recommendations for people with a very low to moderate risk foot. Structured education program was only used by 4 (5%) participants. Public sector podiatrists reported greater provision of custom-made footwear (p = 0.04) and multi-disciplinary team care (p = 0.03). CONCLUSION: NZ podiatrists generally follow international guideline recommendations with respect to screening, self-care education, appropriate footwear, and treatment of risk factors for people at-risk of diabetes-related foot disease. However there may be over-screening of people with very low to medium risk occurring in clinical practice. Increasing access to integrated healthcare, custom-made footwear and structured educational programmes appear to be areas of practice that could be developed in future to help prevent diabetes-related foot disease in NZ.

Perceptions and satisfaction of a mandatory continuing professional development programme amongst Aotearoa New Zealand podiatrists.

BACKGROUND: Aotearoa New Zealand (NZ) registered podiatrists are required to participate in a mandatory continuing professional development (CPD) programme. This study investigated podiatrist's perceptions and satisfaction surrounding mandatory CPD requirements following the implementation of a new 2-year CPD programme. METHODS: A cross-sectional study of NZ registered podiatrists was conducted between October 9th and December 9th, 2020. Data was collected using a web-based survey. The 39-item survey included questions to elicit participant characteristics, perceptions of CPD, difficulties undertaking CPD, and satisfaction with the new CPD programme. The survey findings were reported using descriptive statistics and conventional content analysis. RESULTS: One hundred and thirty-four podiatrists completed the survey. Most respondents worked in private practice (n = 107, 80 %), were in full-time employment (n = 83, 62 %), and had greater than 16 years of work experience (n = 73, 54 %). Respondents agreed it was important to engage in CPD (n = 126, 94 %) and reported that knowledge gained from CPD contributed to their daily work (n = 78, 58 %). 44 % (n = 58) reported difficulties keeping up to date with CPD. The main barriers to CPD participation reported were workload (n = 90, 67 %) and lack of time (n = 84, 63 %). Three categories (understanding the CPD programme; access to CPD; and time to complete CPD) were identified from the qualitative analysis to describe why it was difficult to meet CPD requirements. CONCLUSIONS: NZ podiatrists value CPD and are satisfied with most aspects of the mandatory CPD programme apart from the hours attributed to compulsory activities. The current approach to cultural safety CPD requires revision, with a move away from a time-based approach to a system that promotes an understanding and relevance to practice. Lack of time, practice workload, financial barriers, geographical location, and employment context were factors that influenced a practitioner's ability to engage in CPD. Facilitation of CPD activities that are flexible to ensure relevance to the practitioner's specific work within their scope of practice, and that can occur in the workplace environment, may address barriers and increase engagement with to CPD activities.

The New Zealand podiatry profession - a workforce in crisis?

BACKGROUND: This is the first study to explore workforce data from the Podiatrists Board of New Zealand. The study analysed data from an online survey which New Zealand podiatrists complete as part of their application for an Annual Practising Certificate. METHODS: Survey responses between 2015 and 2019 were analysed. Data was related to work setting, employment status, work hours, location, professional affiliations, and number of graduates entering practice. Survey data was downloaded by a second party who provide data security for the Podiatrists Board of New Zealand workforce data. All data supplied for analysis were deidentified and could not be re-linked to an individual practitioner. RESULTS: In 2019 there were 430 podiatrists who held an Annual Practising Certificate. Eighty percent of podiatrists who work in New Zealand are in private practice, with 8% employed in the public health sector. Podiatrist's work is a mix of general podiatry, diabetes care and sports medicine. The majority are self-employed (40%) or business owners (19%). Approximately 40% work between 31 to 40 h per week and 46 to 50 weeks per year. The majority are female (67%) with most practising in the North Island (69%) and located in the Auckland region (33%). On average 76% of new graduates were issued an Annual Practising Certificate between 2015 and 2019. CONCLUSION: The New Zealand podiatry profession is small and growing at a slow rate, consequently there is evidence of a workforce shortage. To maintain a per-capita ratio of podiatrists approximate to Australia and the United Kingdom an additional 578 podiatrists are required in the New Zealand workforce. There are not enough new graduate practitioners entering the workforce and once practising, the majority enter private practice in the face of limited public health employment opportunities.