Reducing the burden of chronic wounds: prevention and management of the diabetic foot in the context of clinical guidelines.
OBJECTIVE
Chronic wounds such as diabetic foot and venous leg ulcers are a major burden for health services. Our programme was developed to explore the psychological and behavioural factors that may influence both the incidence of chronic wounds and their progression. The present article focuses on two particular aspects of the programme: patient knowledge of diabetic foot ulceration and factors influencing foot-related behaviour in patients with and without foot ulcers; and patient and podiatrist perspectives of consultations for diabetic foot ulcers.


METHODS
Two independent qualitative studies were undertaken: one with diabetic patients without a history of ulceration; and the other with diabetic patients with active ulceration and podiatrists treating these patients.


RESULTS
We found that patients may find it difficult understanding the rationale underlying prevention and treatment of foot ulcers; ulcerated patients may find it difficult to engage in the management of their foot ulcer outside consultations; and some podiatrists feel frustrated and unsupported in their attempts at empowering and building partnerships with patients.


CONCLUSIONS
Patient and practitioner factors may contribute to the effective implementation of clinical guidelines regarding education, partnership building and shared decision-making. These findings are discussed in relation to patient education, partnership building and shared decision-making as recommended in NICE guidelines.
Searle
Aidan
A
Department of Social Medicine, University of Bristol, Bristol, UK.
Gale
Lone
L
Campbell
Rona
R
Wetherell
Mark
M
Dawe
Karen
K
Drake
Nikki
N
Dayan
Colin
C
Tarlton
John
J
Miles
Jeremy
J
Vedhara
Kavita
K
D000368:Aged; D017281:Cost of Illness; D003657:Decision Making; D017719:Diabetic Foot / Q000517:prevention & control* / Q000628:therapy*; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D012648:Self Care