Assessment of documented foot examinations for patients with diabetes in inner-city primary care clinics.
BACKGROUND
The established guidelines for a diabetes foot examination include assessing circulatory, skin, and neurological status to detect problems early and reduce the likelihood of amputation.


OBJECTIVE
To determine documented adherence with guidelines for foot examinations.


METHODS
Four clinics in underserved areas.


METHODS
Charts of 350 diabetic patients, identified by billing code, were reviewed for foot examination documentation. A documented foot examination was defined as assessing at least two of the three components of a foot examination. The review determined the periodicity and prevalence of foot examinations, referrals to a podiatrist or vascular surgeon during a 2-year period, and risk factors for foot complications. Stepwise logistic regression was used to determine whether risk factors for foot complications predicted foot examination status.


RESULTS
The patients had a mean age and duration of diabetes of 57.7 and 8.8 years, respectively; 86% were black or Hispanic. There was no indication of foot examination or referral for 55.7% of the patients during the 2-year period. Patients with foot care referrals were more likely to have foot examinations by their primary care providers (P = .0001). There was almost a fourfold increase in the odds that patients with diagnosed peripheral vascular disease had foot examinations, with twofold greater odds for each 25-year increase in age.


CONCLUSIONS
Populations at risk of diabetic complications are unlikely to have foot examinations in their primary medical care, but having peripheral vascular disease increases the likelihood. Efforts are needed to improve adherence to foot examination guidelines for patients with diabetes from underserved populations.
Wylie-Rosett
J
J
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
Walker
E A
EA
Shamoon
H
H
Engel
S
S
Basch
C
C
Zybert
P
P
D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D017719:Diabetic Foot / Q000517:prevention & control*; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008499:Medical Records; D008507:Medically Underserved Area; D008875:Middle Aged; D010808:Physical Examination; D011320:Primary Health Care; D014504:Urban Health