title: An integrated wound-care pathway, supported by telemedicine, and competent wound management-Essential in follow-up care of adults with diabetic foot ulcers.
abstract: Diabetic foot ulcers are a feared complication of diabetes. Care delivered via telemedicine is suggested to be a more integrated care pathway to manage diabetic foot ulcers than traditionally delivered healthcare. Our aim was to explore patients' experiences with telemedicine follow-up care as compared to traditional care.
  
  
  
  Interpretive description was used as an analysis strategy. Data were collected using individual semi-structured interviews in the context of a larger ongoing clustered randomized controlled trial. Twenty-four patients (13 in the intervention group; 11 in the control group), aged 38-88 years were purposively recruited from the RCT in order to obtain a diverse sample in terms of group composition (intervention vs. control), age, gender, marital status, setting, and comorbidities present. The control group received traditional care.
  
  
  
  Three themes emerged from the interpretive analysis: competence of healthcare professionals, continuity of care, and easy access. This was independed of types of follow-up that had limited impact on the patients' follow-up experiences. Competence of healthcare professionals and continuity of care were crucial, because they can either enhance or jeopardize wound care. If these two latter factors were absent, patients would lose confidence in the wound care process. If this happened, patients pointed out that the expert knowledge of a specialist clinic was essential to receive good care. When telemedicine functioned optimally, telemedicine was an advantage in the treatment, because the images quickly captured changes in the wound healing that immediately could be corrected. Easy access is important for patients, but the importance of accessibility appears to be primary when the other two factors were present.
  
  
  
  The best wound care pathway for patients with diabetes foot ulcers is depended on a combination of competence and professional skills in wound management, and continuity of care. If telemedicine is functioning as intended, it can be an important additional tool.
authors: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway, Norway. Electronic address: hss@hib.no.
authors: Hilde
authors: H
authors: Smith-Strøm
authors: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway; Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
authors: Marjolein M
authors: MM
authors: Iversen
authors: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway.
authors: Marit
authors: M
authors: Graue
authors: Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
authors: Svein
authors: S
authors: Skeie
authors: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway; Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors: Marit
authors: M
authors: Kirkevold
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration; D014945:Wound Healing
keywords: Continuity of care; Diabetic foot ulcer; Home care nurse; Patient security; Professional competence; Randomized controlled study; Telemedicine