title: Experiences of healthcare provision for foot ulceration occurring in people with rheumatoid arthritis.
abstract: BACKGROUND
  Participants with rheumatoid arthritis (RA) report that foot ulceration has an impact on their health-related quality of life (HRQL) across physical, social and psychological domains. What is not known is how experiences of healthcare provision influence HRQL. The present study set out to map the patent journey while integrating the impact on HRQL.
  
  
  METHODS
  A purposive sample of RA patients with open foot ulceration was recruited from podiatry clinics in West Yorkshire (UK) between May 2008 and June 2009. Patients with diabetes were excluded (the impact of foot ulceration in this group is well established). In-depth interviews were taped and transcribed. A framework approach to data management was used to facilitate a case- and theme-based analysis.
  
  
  RESULTS
  Twenty-three RA patients (18 female, five male; aged 45-88 years) participated. Two themes and five sub-themes were identified. The patient journey theme comprised the following sub-themes: access to care; knowledge acquisition; care pathways and continuity of care. Patient-professional relationships comprised the sub-themes: therapeutic patient-professional relationships and task-orientated care. The journey took a highly variable course that was influenced by patient-specific factors (past experience of ulceration; symptomology; knowledge and self-efficacy); service-specific factors (access to care and care pathways) and professional-specific factors (knowing and trusting someone; holism).
  
  
  CONCLUSIONS
  The present study highlights the need for clearer care pathways for patients affected by foot ulceration improved patient education and better coordination of care.
authors.affiliation: Pennine Musculoskeletal Partnership Ltd, Oldham, UK. Jill.Firth@nhs.net
authors.forename: Jill
authors.initials: J
authors.lastname: Firth
authors.forename: Andrea
authors.initials: A
authors.lastname: Nelson
authors.forename: Michelle
authors.initials: M
authors.lastname: Briggs
authors.forename: Claudia
authors.initials: C
authors.lastname: Gorecki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000523:psychology / Q000628:therapy; D003153:Community Health Services; D003266:Continuity of Patient Care; D019091:Critical Pathways; D005260:Female; D016523:Foot Ulcer / Q000150:complications / Q000523:psychology / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011032:Podiatry; D036301:Qualitative Research; D011788:Quality of Life