Journal of Health Services Research & Policy > Volume 13, Supplement 3 > Pp. 82-91

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Original research

Reducing the burden of chronic wounds: prevention and management of the diabetic foot in the context of clinical guidelines

Aidan Searle, Lone Gale, Rona Campbell, Mark Wetherell ¹, Karen Dawe, Nikki Drake ², Colin Dayan ³, John Tarlton ⁴, Jeremy Miles ⁵, Kavita Vedhara 

Department of Social Medicine, University of Bristol, Bristol, UK; ¹ School of Psychology and Sports Sciences, University of Northumbria, Newcastle upon Tyne, UK; ² Department of Podiatry, Southmead Hospital, Bristol, UK; ³ Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK; ⁴ Matrix Biology Research Group, University of Bristol, Bristol, UK; ⁵ Rand Corporation, Santa Monica, California, USA

Correspondence to: k.vedhara{at}bristol.ac.uk

Objectives: Chronic wounds such as diabetic foot and venous leg ulcers are a major burden for health services. Our programme was developed to explore the psychological and behavioural factors that may influence both the incidence of chronic wounds and their progression. The present article focuses on two particular aspects of the programme: patient knowledge of diabetic foot ulceration and factors influencing foot-related behaviour in patients with and without foot ulcers; and patient and podiatrist perspectives of consultations for diabetic foot ulcers.

Methods: Two independent qualitative studies were undertaken: one with diabetic patients without a history of ulceration; and the other with diabetic patients with active ulceration and podiatrists treating these patients.

Results: We found that patients may find it difficult understanding the rationale underlying prevention and treatment of foot ulcers; ulcerated patients may find it difficult to engage in the management of their foot ulcer outside consultations; and some podiatrists feel frustrated and unsupported in their attempts at empowering and building partnerships with patients.

Conclusion: Patient and practitioner factors may contribute to the effective implementation of clinical guidelines regarding education, partnership building and shared decision-making. These findings are discussed in relation to patient education, partnership building and shared decision-making as recommended in NICE guidelines.

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