Diabetes is on the rise, with Health Canada recently elevating it to one of the top health priorities of the country. Complications associated with diabetes are largely preventable and when they occur they negatively impact costs to the health care system and individual productivity in our society. Up to one-quarter of people with diabetes (PWD) experience foot ulceration (FU), with FU preceding lower extremity amputations (LEA) in 85% of cases. Of further significance is that almost two-thirds of PWD who undergo LEA die within 5 years of having these amputations. Hence, there is a significant need to prevent the development of FU and provide more effective treatment. The most effective approaches to date are through the use of interprofessional teams working with PWD and FU. Such teams can address the complexities of health and psychosocial factors of PWD, to create co-ordinated care provision with implementation and evaluation of strategies to address this problem.
An 18 month project was funded by the Ministry of Health and Long Term Care, under the auspices of Health Force Ontario, Interprofessional Care/Education Fund to create an Interprofessional Client-centred Diabetic Foot Ulcer Team (IP-DFUT). Drs Rajna Ogrin and Pamela Houghton, from the School of Physical Therapy University of Western Ontario (UWO), in collaboration with Dr Irene Hramiak and the Diabetes Education Centre of St. Joseph’s Health Care and Dr. William Thompson from London Health Sciences Centre with support from Dr Carole Orchard and the Office of Interprofessional Health Education and Research (IPHER), have brought together 9 different health disciplines to form an IP team to prevent and manage FUs in PWD.
The IP-DFUT consists of the following health professionals:
A diabetes foot ulcer Chiropodist, a community Chiropodist; an Orthotist; a Wound Nurse; a Physical Therapist; a Nurse Diabetes Educator; 2 Dietitian Diabetes Educators; a Social Worker; a Clinical Psychologist; an Infectious Diseases physician.
Team building was provided in a structured format by IPHER and directed by Dr. Carole Orchard. The team building process involved all team members as well as three PWD who had a history of foot ulceration in the past. The clinicians undertook four, three hour on-line sessions outlining the theoretical components of IP care, followed by six, weekly two-hour face-to-face workshops that entailed the following: developing common goals for the team; identifying roles and responsibilities; developing principles for working together as a team; guidelines for communication; dealing with conflicts; including patients as team members; defining patient centred care; what services are provided by the team; developing a process of care for patients who are seen by the team, including developing forms for use by the team. Patients who had a history of foot ulcers undertook a one hour orientation session prior to attending the final four face-to-face workshops.
The aim of the project was to provide a fully IP, patient-centred approach to the care of PWD with FU. Additionally, the IP-DFUT contributed to the creation of a toolkit, including the processes undertaken by the IP-DFUT to build their IP team. The toolkit was fully developed by IPHER and is available as a resource to administrators and health professionals throughout Ontario to guide similar teams in other facilities. Interprofessional groups of students were provided with practice placements with the IP-DFUT, and working clinicians were invited to spend time at the team clinic in order to observe the new model of care.
Evaluation of the IP-DFUT project has been undertaken by researchers with Sociology and Interprofessional Team Functioning expertise, headed by Dr Tracey Adams, from UWO. A key feature in this evaluation is the perspective of the patients in their care and self-management.
The expected outcomes from this project are:
- Increased patient inclusion in care, helping empower patients, to increase their effective self-management practices and improve their health outcomes.
- Increased team member collaboration and socialization, resulting in improved job satisfaction.
- Improved student understanding of the nature of collaboration within IP teams, and the value of including patients within team discussions.
- Reduced hospitalizations, length of stay and amputations for PWD treated through the IP-DFUT.
Also from this web page:
Initiatives Focusing on IPE or IPCP
»The Final Toolkit Access (coming soon)
»The Final Report Summary