PDF(Pubmed)
Abstract：
BACKGROUND: Pacific Island Countries and Territories (PICTs) are known to have high prevalence of Diabetes Mellitus and high incidence of diabetes-related foot disease. Diabetes-related foot disease can lead to lower limb amputation and is associated with poor outcomes, with increased morbidity and mortality. The purpose of this study was to gain a better understanding of diabetes-related foot disease management in selected countries in PICTs and to identify potential barriers in management of diabetes-related foot disease management in the region.
METHODS: A cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks.
RESULTS: Seven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development.
CONCLUSIONS: Despite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.
METHODS: A cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks.
RESULTS: Seven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development.
CONCLUSIONS: Despite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.
摘要：
背景：已知太平洋岛屿国家和地区（PICT）的糖尿病患病率高，与糖尿病相关的足部疾病发病率高。糖尿病相关的足部疾病可导致下肢截肢，并与不良预后相关。发病率和死亡率增加。这项研究的目的是更好地了解PICT中某些国家与糖尿病相关的脚病管理，并确定该地区与糖尿病相关的脚病管理的潜在障碍。
方法：对6家选定的PICT的11家医院进行了横断面调查。该调查工具旨在提供与糖尿病相关的足部疾病的概述（入院人数，以及12个月内下肢截肢的次数），并确定每个机构内可用的临床服务。文书中包括两个开放式问题（自由文本答复），以探索有助于改善与糖尿病有关的足部疾病的管理和治疗的举措，以及临床医生在治疗与糖尿病相关的足部疾病时遇到的障碍。调查进行了6周。
结果：四个国家的七家医院提供了答复。与糖尿病相关的足部疾病相关的入院和截肢数量仅作为临床医生的估计报告。糖尿病相关的足部疾病主要由全科医生管理，接受调查的医院的普通外科医生和/或整形外科医生，因为该地区没有亚专业服务。只有一家医院可以接受门诊足病治疗。临床医生在糖尿病相关足部疾病管理中面临的障碍所确定的共同主题广泛集中在资源可用性上。意识和教育，和专业发展。
结论：尽管PICT中糖尿病相关足部疾病的患病率很高，似乎缺乏功能性的多学科步行服务（MDF）。为了改善该地区与糖尿病相关的足部疾病患者的预后，有必要建立实用的MDF，并让国际利益攸关方以教育形式提供持续支持，指导,以及物理资源。
方法：对6家选定的PICT的11家医院进行了横断面调查。该调查工具旨在提供与糖尿病相关的足部疾病的概述（入院人数，以及12个月内下肢截肢的次数），并确定每个机构内可用的临床服务。文书中包括两个开放式问题（自由文本答复），以探索有助于改善与糖尿病有关的足部疾病的管理和治疗的举措，以及临床医生在治疗与糖尿病相关的足部疾病时遇到的障碍。调查进行了6周。
结果：四个国家的七家医院提供了答复。与糖尿病相关的足部疾病相关的入院和截肢数量仅作为临床医生的估计报告。糖尿病相关的足部疾病主要由全科医生管理，接受调查的医院的普通外科医生和/或整形外科医生，因为该地区没有亚专业服务。只有一家医院可以接受门诊足病治疗。临床医生在糖尿病相关足部疾病管理中面临的障碍所确定的共同主题广泛集中在资源可用性上。意识和教育，和专业发展。
结论：尽管PICT中糖尿病相关足部疾病的患病率很高，似乎缺乏功能性的多学科步行服务（MDF）。为了改善该地区与糖尿病相关的足部疾病患者的预后，有必要建立实用的MDF，并让国际利益攸关方以教育形式提供持续支持，指导,以及物理资源。
