The impact of team based interprofessional comprehensive assessments on the diagnosis and management of diabetic foot ulcers: A retrospective cohort study.
The impact of team based interprofessional comprehensive assessments on the diagnosis and management of diabetic foot ulcers: A retrospective cohort study.
复制标题
DOI：
10.1371/journal.pone.0185251
复制
发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Sibbald RG
中科院分区：
文献类型：
--
作者：
Somayaji R;Elliott JA;Persaud R;Lim M;Goodman L;Sibbald RG
糖尿病足溃疡（DFU）越来越普遍，并且与显着的发病率、死亡率和费用相关。鉴于所涉及的病因复杂性，跨专业的 DFU 管理方法至关重要。本研究旨在评估跨专业团队方法对在加拿大安大略省家庭护理机构接受治疗的一组患者的 DFU 诊断和管理的影响。对 2013 年 2 月 11 日至 2014 年 9 月 30 日期间就诊于大型区域社区护理服务中心 (CCAC) 的患者进行了一项回顾性队列研究。 CCAC 转诊后，多伦多地区伤口愈合中心 (TRWHC) 的跨专业团队对患者进行了评估。年龄 > 18 岁且 DFU 持续时间 > 6 周的患者也包括在内。主要结局是与 DFU 病因（即神经病理性、缺血性或混合病因）相关的初始诊断的准确性。次要结果包括伤口愈合和感染参数。使用 STATA 13.1（德克萨斯州大学学院）完成对 2 边 α 为 0.05 的预定结果的分析。总共筛选了 308 名患者，其中 49 名患者（67.3% 男性）平均年龄 64.2 岁（SD 13.7），诊断为 DFU 持续时间 > 6 周，纳入分析。其中，95% 因未明确的 DFU 被转诊，并在 TRWHC 评估后被重新分类为与病因相关的精确诊断，包括神经病变、缺血或神经缺血病因 (p < 0.001)。对于评估后的次要结果，对更大比例的患者进行了可治愈性评估（100% 对比 44%，p < 0.001）。在更多的患者中发现了感染（p = 0.04），在 35 名患者中，94.5% 患有深部和周围感染，88.0% 开始接受全身抗生素治疗。该队列中另外 14.3% 的人被诊断出血管功能不全 (p = 0.03)。对所有患者进行了减重/鞋类评估，相比转诊前的 30.6% (p < 0.001)，TRWHC 评估后换药频率显着下降（前：4.31 次/周；后：3.54 次/周；p = 0.03）。数字评分量表上的疼痛评分有所下降（2.18 至 1.67），但这在最终 TRWHC 评估中并不具有统计显着性。值得注意的是，36.7% (18/49) 的受访者表示，第二次 TRWHC 遭遇后生活质量得到改善。与传统社区护理服务相比，跨专业护理团队可以提高诊断敏锐度和伤口愈合效果。建议采取包括最佳实践跨专业糖尿病足部护理途径在内的举措，包括及时的缺血血管管理、深部和周围感染的治疗以及足部护理和鞋类的可用性。
Diabetic foot ulcers (DFU) are increasingly prevalent, and associated with significant morbidity, mortality, and cost. An interprofessional approach to DFU management is critical given the etiological complexity involved. This study aimed to assess the impact of an interprofessional team approach on DFU diagnosis and management for a cohort of patients receiving treatment in an Ontario Canada home care setting. A retrospective cohort study of patients attending a large regional Community Care Access Centre (CCAC) between February 11, 2013-September 30, 2014 was conducted. Following CCAC referral, patients were assessed by an interprofessional team at the Toronto Regional Wound Healing Centre (TRWHC). Those aged > 18 years with a DFU of > 6 weeks duration were included. The primary outcome was the precision of the initial diagnosis relating to DFU etiology (i.e. neuropathic, ischemic or mixed etiology). Secondary outcomes included wound healing, and infection parameters. Analysis was completed with STATA 13.1 (College Stn., TX) of pre-determined outcomes with 2 sided α of 0.05. A total of 308 patients were screened, and 49 patients (67.3% male) of mean age 64.2 years (SD 13.7) with a diagnosis of DFU > 6 weeks duration were included for analysis. Of these, 95% were referred with unspecified DFU, and were reclassified to a precise diagnosis relating to etiology, including neuropathy, ischemia or neuroischemic etiology following TRWHC assessment (p < 0.001). For secondary outcomes post-assessment, healability assessment was conducted for a greater proportion of patients (100% versus 44%, p < 0.001). Infection was identified in a greater number of patients (p = 0.04), and of the 35 patients, 94.5% had deep and surrounding infection, and 88.0% were initiated on systemic antibiotics. Vascular insufficiency was diagnosed in an additional 14.3% of the cohort (p = 0.03). Offloading/footwear assessment was conducted in all patients compared with 30.6% prior to referral (p < 0.001) Dressing change frequency decreased significantly following TRWHC assessment (pre: 4.31/week; post: 3.54/week; p = 0.03). Pain scores decreased (2.18 to 1.67) on the numerical rating scale but this was not statistically significant at the final TRWHC assessment. Notably, 36.7% (18/49) reported improved quality of life by the second TRWHC encounter. Interprofessional care teams are associated with improved diagnostic acumen and wound healing outcomes over conventional community care services. Initiatives including best practice interprofessional diabetic foot care pathways are recommended with timely vascular management of ischemia, treatment of deep and surrounding infection as well as the availability of foot care and footwear.
登录
查看更多内容
影响因子：
3.5
作者：
Alva, M. L.;Gray, A.;Holman, R. R.
通讯作者：
Holman, R. R.
影响因子：
0.7
作者：
Robbins, Jeffrey M.;Strauss, Gerald;Kaplan, Yelena
通讯作者：
Kaplan, Yelena
影响因子：
4.3
作者：
Sumpio, Bauer E.;Armstrong, David G.;Andros, George
通讯作者：
Andros, George
影响因子：
158.5
作者：
Holman, Rury R.;Paul, Sanjoy K.;Neil, H. Andrew W.
通讯作者：
Neil, H. Andrew W.
影响因子：
16.2
作者：
King, H;Aubert, RE;Herman, WH
通讯作者：
Herman, WH