OUTCOMES FOR PATIENTS WITH DIABETES AND A FOOT ULCER WHO SEE A PODIATRIST vs Those Who Don't...
Authors: Teresa B. Gibson, PhD; Vickie R. Driver, MS, DPM, FACFAS; James Wrobel, DPM, MS; James R. Christina, DPM; Erin Bagalman, MSW; Roy DeFrancis, DPM; Matthew G. Garoufalis, DPM; Ginger S. Carls, PhD; Sara S. Wang, PhD
Summary by Dr Dan Preece:
- Type of Study: retrospective
- Size of the study: 32,000 patients. 20,330 medicare eligible >65 yo, and 11,766 non medicare eligible patients <65 yo.
- Question of the Study: Does having a Podiatrist on the Diabetic Patient’s health care team decrease the rate of major amputations and hospitalizations due to diabetic foot complications?
- Materials and methods:
- Adult patients (>18 years old) with diabetes and a diagnosis of foot ulcer were found in the Thomson Reuters MarketScan® Research Databases, from 2005–2008.
- Patients with a previous history of foot ulcer or amputation within 12 months of first being diagnosed with an ulcer were excluded.
- Patients were noted to either have had one or more visit with a Podiatrist in the 12 months prior to ulceration or not.
- Patients were matched by age, health insurance type, health problems etc. The only difference between the two groups was that of receiving a podiatrist’s care or not.
- Major Points:
- Among non-Medicare patients with foot ulcer, those seen previously by a podiatrist had a 15% lower risk of amputation and a 17% lower risk of hospitalization compared with patients not seen previously by a podiatrist (P < 0.05). The difference in risk of major amputation was not statistically significant between patients receiving care from podiatrists and those who did not (P >0.05).
- Among Medicare-eligible patients with foot ulcer, those seen previously by a podiatrist had an 18% lower risk of amputation, a 23% lower risk of major amputation, and a 9% lower risk of hospitalization compared with patients not seen previously by a podiatrist (all P < 0.05).
Critiques : This was a good study overall. One critique is that patients that were included had employer sponsored insurance, therefore results may not apply to all population groups (ie poverty level groups).
I love this article for the simple reason that it answers the questions, "Why see a Podiatrist?", and "What is so unique about a Podiatrist?". The short answer is that we know the foot and ankle better than the rest of the medical profession. We truly understand the foot and its' many unique characteristics, the challenge with taming the interface between the foot and the earth and how to heal the foot when it becomes damaged. It's nice to see some hard data that demonstrates the uniqueness of our education and the value we bring to the medical field as the only true foot and ankle specialists.
Dan Preece, DPMOffice: 801-532-1822, Fax: 801-532-7544Address: 430 N. 400 W. Salt Lake City, UT 84103E-Mail: [email protected]Website: saltlakecitypodiatrist.netFoot & Ankle SpecialistsKey Words: Diabetes, Diabetic Wounds, Ulcerations, Podiatry Preventative Care, Cost Savings