title: Patient and professional delay in the referral trajectory of patients with diabetic foot ulcers.
abstract: OBJECTIVE
  A cohort study investigated referral and treatment trajectories of patients with diabetic foot ulceration consulting podiatrists. The study aims were to quantify patient, professional and treatment (=total) delay and to identify relationships between patient- or professional-related characteristics, delays or ulcer healing time.
  
  
  METHODS
  Ten podiatrists specialising in diabetes care included 54 consecutive adults with diabetic foot ulceration. Assessments were performed retrospectively (e.g. delays) and prospectively (12 weeks).
  
  
  RESULTS
  Median (SD; range) patient delay was 3.0 days (50.6; 0-243), professional delay 7.0 days (63.4; 0-279) and treatment delay 20.5 days (97.3; 0-522). 57% of patients took >2 weeks before visiting a podiatrist. Ulcers healed in 67% of patients in 49.0 days (90.2; 4-408). The number of health care professionals in the referral trajectory was positively related to treatment delay (p<0.01) and to ulcer healing time (p<0.01). Professional delay and treatment delay was positively correlated with the duration of the podiatric treatment (p<0.05). Patient awareness of ulceration risk tended to decrease the healing time.
  
  
  CONCLUSIONS
  Patients with diabetic foot ulcers presented small median delays in the referral trajectory to podiatrists specialising in diabetes. The study results suggest that reducing the number of health care professionals in the referral trajectory might decrease treatment delay and ulcer healing time. Also improving patient awareness of ulceration risk might be beneficial for the healing time.
authors.affiliation: Dorati Consultancy for Feet and Health, Los Angelesstraat 74, 2548 JC, The Hague, The Netherlands. Electronic address: asanders@dorati.nl.
authors.forename: Antal P
authors.initials: AP
authors.lastname: Sanders
authors.forename: Lian G M C
authors.initials: LG
authors.lastname: Stoeldraaijers
authors.forename: Mieke W M
authors.initials: MW
authors.lastname: Pero
authors.forename: Patty J
authors.initials: PJ
authors.lastname: Hermkes
authors.forename: René C A
authors.initials: RC
authors.lastname: Carolina
authors.forename: Petra J M
authors.initials: PJ
authors.lastname: Elders
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017719:Diabetic Foot / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011032:Podiatry; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014945:Wound Healing
keywords: Diabetic foot; Diabetic neuropathies; Foot ulcer; Referral and consultation; Wound healing