This study also demonstrates that an additional aspect associated to performance of screening is the perception of economic incentives associated to goal achievement in general not necessarily related to care for diabetic patients.
Several authors have shown that pay for performance improves quality of care in chronic diseases, 19,20 and specifically in diabetes, but results tend to regress when incentives are removed. As noted above, distal pulse inspection and examination was most commonly performed. This finding agrees with that reported by Arrieta et al. By contrast, ABI was measured in a low number of patients. The ADA provides no guidelines on who should undergo this test and when, 6 and advises that its relevance is assessed, because peripheral artery disease is often asymptomatic. However, the ADA consensus panel for peripheral vascular disease recommends that ABI is measured in people with diabetes older than 50 years, and should be considered in younger people who have several cardiovascular risk factors, and repeated every five years if normal.
This study has the limitations inherent to an observational study in which information and selection bias cannot be ruled out. Other limitations include lack of center randomization and data sources with deficient records for some variables.. With the above stated limitations, the main study contribution is to confirm deficiencies in diabetic foot screening and risk stratification, which should lead to a reflection on the reasons and prompt the health care administration to take practical measures to promote performance of diabetic foot screening; prevention and foot care programs are highly cost-effective interventions for the care system and for people with diabetes.
The authors state that they have no conflicts of interest in relation to publication of this article.. Castroviejo, Madrid.. Endocrinol Nutr. ISSN: Previous article Next article. Issue 6. Pages June - July Download PDF. Corresponding author. This item has received.
Article information. Table 1. Table 2. Table 3. Show more Show less. Aim To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated with performance of such screening.
Materials and methods A multicenter, epidemiological, cross-sectional study was conducted. Demographic and healthcare variables and characteristics of the Primary Care Center were recorded. Results In the previous year, Conclusions Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor.
Palabras clave:. Introduction The term diabetic foot encompasses any lesion in the feet: infection, ulcer, and destruction of deep tissues occurring as the result of diabetes and its complications. Patients and methods This was a multicenter, descriptive, cross-sectional study where a review was conducted of a random, representative sample of clinical histories from patients with T2DM who attended 17 health care centers non-randomly distributed in 11 Spanish autonomous communities. Patients with minor amputations or major amputations in a single limb were included in the study.
This resulted in a total sample of patients. Two patients were excluded because they did not meet the inclusion criteria, and data from patients were therefore finally analyzed. Variables collected included active smoking if recorded in the clinical history; diabetic retinopathy if diagnosed by retinography or eye fundus examination by an ophthalmologist, or recorded in a hospital report; neuropathy, PAD, and history of amputation if recorded in clinical history or any hospital report; history of foot ulcers if recorded in the medical history or center records included care for this reason; and foot deformities if clinical history included presence of hallux valgus, claw or hammer toes, pes cavus, flat foot, or any other deformity.
In compliance with the criteria of the Clinical Practice Guidelines of the Ministry of Health, 7 screening was considered to be performed if inspection, peripheral pulse examination, and a monofilament test were recorded. Results Data from the clinical histories of patients with T2DM were collected. Table 1 summarizes the prevalence of risk factors for ulcers. CI: confidence interval. Proportion of patients given education, taken a clinical history, and performed examination.
Stratification of foot ulcer risk in patients with diabetes according to the criteria of the International Consensus on the Diabetic Foot.
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International Working Group on the Diabetic Foot. Table 4. Risk factors for ulcer and performance of screening. CI: confidence interval; OR: odds ratio. Chi-square test. Each of the 17 PC teams is represented in ordinates; teams 15, 16, and 17 performed no screening in any patient. Figure 1. Table 5. Center characteristics and performance of screening. Castroviejo, Madrid.
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