背景:糖尿病相关性足溃疡(DFU)是生活质量受损的主要原因,残疾,住院治疗,糖尿病患者的截肢和死亡率。因此,至关重要的是,所有设置的足病医生,包括社区设置,有信心并能够为糖尿病相关的足部并发症提供护理。本研究旨在描述当前的实践,社区足病医生对足部溃疡患者管理的信心和焦虑水平。此外,还将探索当前提供服务的障碍和对未来教育机会的兴趣。
方法:向澳大利亚社区足病医生分发了一项在线横断面调查。描述性变量,包括性别,年龄,专业经验,引出了练习地点和练习设置。使用改良的竞争性状态焦虑量表2(CSAI-2)来测量与治疗足部溃疡有关的焦虑。其他问题包括多项选择和与评估有关的开放式自由文本答复的组合,信心和转诊途径。
结果:有122名澳大利亚社区足病医生对调查做出了回应。据报道,在社区环境中可以管理各种溃疡的大小和复杂性。在大多数手动技能领域,对DFU管理的信心很高,包括:脚的稳定性(85.7%,标准偏差[SD]17.42),手术刀控制(83.0%,SD20.02),用手术刀清创(82.7%,SD18.19)和无菌技术(81.0%,SD18.62,保持健康组织的完整性(77.3%,SD21.11),去除适当的组织(75.6%,SD22.53),溃疡深度(73.7%,SD23.99)和处理凌乱伤口的能力(69.1%,SD26.04)。刮匙清创术的报告置信水平大大降低(41.0%,SD34.24)。CSAI-2上的表现焦虑较低,躯体焦虑和认知焦虑分别为6/24和3/8。
结论:社区足病医生正在治疗不同大小和复杂性的足部溃疡。自信和焦虑不会成为护理的障碍。对伤口评估临床指南的依从性较低,使用刮匙的信心次优。进一步的教育计划可以克服这些障碍,并支持社区和急性足病服务之间的共享护理模式。
BACKGROUND: Diabetes related foot ulcer (DFU) is a leading cause of impaired quality of life, disability, hospitalisation, amputation and mortality in people with diabetes. It is therefore critical that podiatrists across all settings, including community settings, are confident and capable of providing care for diabetes-related foot complications. This study aims to describe current practice, confidence and anxiety levels of community podiatrists in the management of patients with foot ulceration. Furthermore, current barriers to service provision and interest in future educational opportunities will also be explored.
METHODS: An online cross-sectional survey was distributed to Australian community podiatrists. Descriptive variables including gender, age, professional experience, practice location and practise setting were elicited. A modified competitive State Anxiety Inventory-2 (CSAI-2) was utilised to measure anxiety related to managing a foot ulcer. Other questions included a combination of multiple choice and open-ended free-text responses relating to assessment, confidence and referral pathways.
RESULTS: One hundred and twenty-two Australian community-based podiatrists responded to the survey. A variety of ulcer sizes and complexity were reported to be managed in community settings. Confidence in DFU management was high in most manual skill domains including: stabilisation of the foot (85.7%, standard deviation [SD] 17.42), scalpel control (83.0%, SD 20.02), debridement with a scalpel (82.7%, SD 18.19) and aseptic technique (81.0%, SD 18.62, maintaining integrity of healthy tissue (77.3%, SD 21.11), removal of appropriate tissue (75.6%, SD 22.53), depth of ulceration (73.7%, SD 23.99) and ability to manage messy wounds (69.1%, SD 26.04). Curette debridement had substantially lower levels of reported confidence (41.0%, SD 34.24). Performance anxiety was low with somatic and cognitive anxiety of 6/24 and 3/8 on the CSAI-2, respectively.
CONCLUSIONS: Community podiatrists are managing foot ulcers of varying size and complexity. Confidence and anxiety do not pose a barrier to care. Adherence to wound assessment clinical guidelines is low and confidence with the use of curette was sub-optimal. Further educational programs may overcome these barriers and support shared models of care between community and acute podiatry services.