title: Pre-hospital delay in patients with diabetic foot problems: influencing factors and subsequent quality of care.
abstract: OBJECTIVE
  To assess pre-hospital patient delay and its associated variables in patients with diabetic foot problems.
  
  
  METHODS
  We classified 270 patients with diabetic foot problems retrospectively based on the distribution of pre-hospital delay. Clinical, demographic and socio-economic data were collected. Logistic regression analysis was performed to examine independent associations with patient delay.
  
  
  RESULTS
  The median pre-hospital delay time was 46.49 days. Patients reported short (≤ 1 week; 77 patients, 28.5%), moderate (> 1 week and ≤ 1 month; 106 patients, 39.3%) and long delays (> 1 month; 87 patients, 32.2%). In a univariate analysis, nine variables were associated with a longer delay (P < 0.05): (1) no previous ulcer; (2) no health insurance; (3) poor housing conditions; (4) low income level; (5) low educational level; (6) infrequent foot inspection; (7) few follow-up medical visits; (8) absence of diabetic foot education; (9) lack of knowledge of foot lesion warning signals. A multivariate analysis showed that absence of diabetic foot education (odds ratio 2.70, 95% CI 1.03-7.06, P = 0.043) and lack of knowledge of foot lesion warning signals (odds ratio 2.14, 95% CI 1.16-3.94, P = 0.015) were independent predictors of long patient delay. Long delay increased the risk of amputation (odds ratio 2.22, 95% CI 1.36-3.64, P = 0.002) and mortality (odds ratio 2.69, 95% CI 1.35-5.33, P = 0.005).
  
  
  CONCLUSIONS
  A number of factors were involved in pre-hospital delay among patients with diabetic foot problems and contributed to poor outcomes. We recommend developing a community intervention programme that targets at-risk communities to encourage earlier multidisciplinary team assessment to reduce disparities and improve foot outcomes in patients with diabetes.
authors.affiliation: Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: J
authors.initials: J
authors.lastname: Yan
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.forename: B
authors.initials: B
authors.lastname: Zhou
authors.forename: M
authors.initials: M
authors.lastname: Sun
mesh_terms: D000368:Aged; D002681:China; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000150:complications* / Q000628:therapy*; D017719:Diabetic Foot / Q000209:etiology* / Q000628:therapy*; D004522:Educational Status; D005260:Female; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011787:Quality of Health Care / Q000592:standards*; D012044:Regression Analysis; D012189:Retrospective Studies; D012923:Social Class; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome