title: Podiatrist care and outcomes for patients with diabetes and foot ulcer.
abstract: We examined whether outcomes of care (amputation and hospitalisation) among patients with diabetes and foot ulcer differ between those who received pre-ulcer care from podiatrists and those who did not. Adult patients with diabetes and a diagnosis of a diabetic foot ulcer were found in the MarketScan Databases, 2005-2008. Multivariate Cox proportional hazard models estimated the hazard of amputation and hospitalisation. Logistic regression estimated the likelihood of these events. Propensity score weighting and regression adjustment were used to adjust for potentially different characteristics of patients who did and did not receive podiatric care. The sample included 27 545 patients aged greater than 65+ years (Medicare-eligible patients with employer-sponsored supplemental insurance) and 20 208 patients aged lesser than 65 years (non Medicare-eligible commercially insured patients). Care by podiatrists in the year prior to a diabetic foot ulcer was associated with a lower hazard of lower extremity amputation, major amputation and hospitalisations in both non Medicare-eligible commercially insured and Medicare-eligible patient populations. Systematic differences between patients with diabetes and foot ulcer, receiving and not receiving care from podiatrists were also observed; specifically, patients with diabetes receiving care from podiatrists tend to be older and sicker.
authors: Truven Health Analytics, Ann Arbor, MI, USA.
authors: Teresa B
authors: TB
authors: Gibson
authors: Vickie R
authors: VR
authors: Driver
authors: James S
authors: JS
authors: Wrobel
authors: James R
authors: JR
authors: Christina
authors: Erin
authors: E
authors: Bagalman
authors: Roy
authors: R
authors: DeFrancis
authors: Matthew G
authors: MG
authors: Garoufalis
authors: Ginger S
authors: GS
authors: Carls
authors: Justin
authors: J
authors: Gatwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D016208:Databases, Factual; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011032:Podiatry; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Amputation; Diabetes; Foot ulcer; Podiatrist
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