RESUMEN
AIM: To investigate at a national level the multidisciplinary team (MDT) care of patients with diabetes mellitus and foot complications. METHODS: A questionnaire was sent to all 75 Swedish hospitals with emergency departments, which were grouped according to size. RESULTS: The response rate was 92%, 58/69 of the hospitals have a foot team. Most teams have access to an internal medicine specialist/diabetologist, podiatrist and orthotist. Fewer teams reported access to an orthopaedic surgeon and infectious diseases specialist and only half to a vascular surgeon. In joint MDT outpatient evaluations, the majority report the presence of an internal medicine specialist, podiatrist and orthotist, but 50% an infectious disease specialist and orthopaedic surgeon and only a few a vascular surgeon. In hospitalized patients, there is a reduction in the presence of all specialists. The registration of amputation rate and healed foot ulcers is low. CONCLUSIONS: MDT care is mostly adopted among large and medium-sized hospitals in contrast to small ones, which could reflect unequal health care. Vascular surgeons seldom are present at MDT evaluations and there is a reduced regular input of specialists in the evaluation of hospitalized patients. The hospitals' ability to evaluate their work by potential quality control markers is poor.
Asunto(s)
Amputación Quirúrgica/métodos , Pie Diabético/terapia , Úlcera del Pie/terapia , Pie Diabético/patología , Femenino , Úlcera del Pie/patología , Humanos , Masculino , Encuestas y Cuestionarios , SueciaRESUMEN
AIMS: Osteoarthropathy, a rare foot complication in patients with diabetes mellitus, calls for immediate and optimal management to prevent irreversible bone/joint destruction and risk of amputation. Awareness of the condition and adequate guidelines would minimize the consequences and the costs, both for the patient and for the society. We investigated the diabetic osteoarthropathy care in Swedish orthopedic clinics. METHODS: A questionnaire was distributed to 63 Swedish hospitals with emergency department for orthopedic patients. There was a 95% response rate. RESULTS: Most of the respondents (79%) specified absence of established procedures including guidelines for managing patients with osteoarthropathy. The most common diagnostic method was clinical diagnosis and plain X-ray (95%). MRI or scintigraphy was used by 19% and 10.5% respectively. As treatment method, 84% used a total contact cast, while 38% used orthoses. Treatment duration <3 months was reported in 4%, 3-6 months in 53% and 6-12 months in 28% of the clinics. Four clinics reported treatment duration >12 months and two clinics provided no treatment. CONCLUSION: Our national inventory indicates a need for improvement in knowledge as well as guidance and organization at orthopedic clinics regarding optimal care of patients with diabetic osteoarthropathy.