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01-12-2014 | Research | Uitgave 1/2014 Open Access

Journal of Foot and Ankle Research 1/2014

The assessment and management of diabetes related lower limb problems in India-an action research approach to integrating best practice

Tijdschrift:
Journal of Foot and Ankle Research > Uitgave 1/2014
Auteurs:
Michael Harrison-Blount, Michelle Cullen, Christopher J Nester, Anita E Williams
Belangrijke opmerkingen

Competing interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Authors’ contributions

MHB Facilitated and led the focus groups, Transcribed and analysed the data and drafted the manuscript. MC acted as research assistant during the focus groups and contributed towards the literature review. AW and CN acted as PhD supervisors for MHB. All authors read and approved the final manuscript.

Abstracts

Background

In this article the authors explore the current issues and barriers related to achieving successful outcomes to diabetic foot complications in India. This was achieved by engaging clinicians in taking ownership of the problems and facilitating them in the identification of solutions to action change in clinical practice.

Methods

This was accomplished through facilitating participants in this study via a process of problem identification and planning, the first phases of an action research cycle approach. The methods of data collection were focus groups, observations and individual conversations. The data were analysed using a thematic framework.

Results

Based on the practitioner’s experiences and opinions, key themes were identified. These themes had the potential to inform the changes needed in clinical practice, to overcome barriers and embed ownership of the solutions. Five themes were identified highlighting: concerns over a fragmented service; local recognition of need; lack of standardised care pathways; lack of structured assessment and an absence of annual foot screening. Combined, the issues identified were thought to be important in preventing timely assessment and management of foot problems.

Conclusion

It was unanimously agreed that a formalised process of foot assessment should be developed and implemented as part of the subsequent phases of the action research process, which the authors intended to take forward and report in a further paper. The aim of which is to guide triage, education, care pathways, audit and evaluation of outcomes. Facilitation of the clinicians in developing a program and screening tool to implement and teach these skills to others could be an important step in reducing the number of high-risk cases that are often resulting in the amputation of limbs.

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