Quality of care and outcomes in diabetic foot problems in Barbados - abstract

ABSTRACT

In Barbados problems of the feet in diabetics account for a large proportion of the patients in the general surgical wards, 80 percent in the females and 50 percent in the male wards. Many of the patients have major amputations for problems which could have been prevented. A prospective study was undertaken of all cases admitted over a six-month period with a foot problem to the general surgical wards of the Queen Elizabeth Hospital. Data were entered by the junior hospital staff on a questionnaire which had items related to the quality of care and outcomes of the patients. Data were analysed using the E.I. Info Programme (EP16). Statistical significance was established using Chi square analysis for trend, and the Fisher exact probability tests. 195 patients were admitted to the study 55 percent were females. 67.5 percent of the patients were diabetic with no significant gender difference. The peak age on admission was in the 8th decade, with significantly more diabetics than non-diabetics in the 4th to 6th decade. Foot problems in diabetics were precipitated by events that are condsidered trivial in non-diabetic patients. Few patients were newly diagnosed diabetics, the mode being 10 to 19 years. 87 (58 percent) of 150 patients responding had their feet insepected by health personnel in the previous year. The majority of those who responded about the care of their nails (47/74), said that they took care of their nails themselves. Nearly 40 percent of patients, both diabetic and non-diabetic, had not reported source of care before their admission. Only 14 patients, 10 of whom were diabetic, sought care the same day and 11 (9 diabetics) the next day. Most patients presented with infection as part of their problem and recognition of the early sign of infections should be an integral part of the education of the diabetic. Any educational effort that is done for patients needs to be constantly reinforced since many patients said they had had no education about the care of their feet in the last year. AU.