Introduction: Foot disease in diabetes is associated with significant morbidity and mortality. Diabetic foot disease requires complex care with input from a range of healthcare professionals. Scottish Intercollegiate Guidelines Network guideline 116 recommends that all patients with diabetes and foot ulceration are seen at a multidisciplinary foot clinic. Our aim was to assess the impact on patient outcomes of introducing a multidisciplinary foot clinic within NHS Fife.
Methods: The patient group was patients with diabetes with at least one foot ulcer which had not healed within 28 days of presentation. Retrospective data was collected regarding patient demographics, wound healing, amputation rates, cardiovascular risk profile, and mortality, for patients attending the multidisciplinary foot clinic between September 2012 and September 2013. This was compared with data collected from patients receiving specialist podiatrist care only between September 2011 and March 2012.
Results: We collected data from 31 patients from the multidisciplinary clinic, and 137 patients from the specialist podiatry clinics. Our results demonstrate a trend towards a higher rate of wound healing amongst patients attending the multidisciplinary clinic (72.5% vs 62.1%, P=0.2). There was a significant reduction in the need for major amputations amongst multidisciplinary attendees (2.5% vs 11%, P=0.04). Patients attending the multidisciplinary clinic also demonstrated an improvement in cardiovascular risk profile (HbA1c reduced from 79.5 to 65.5 mmol/mol, P=0.00002, mean systolic blood pressure reduced from 136 to 127 mmHg, P=0.026, mean diastolic blood pressure reduced from 74 to 69 mmHg, P=0.006, and cholesterol reduced from 4.28 to 3.67 mmol/l, P=0.0009). No significant improvement in cardiovascular risk profile was seen amongst podiatry clinic attendees. Mortality at 12 months was significantly reduced amongst multidisciplinary clinic attendees compared with podiatry clinic attendees (0% vs 19.0%, P=0.01).
Conclusion: Our study demonstrates that the introduction of a multidisciplinary foot clinic has had a positive impact on patient outcomes. We aim to secure resources to establish an ongoing multidisciplinary foot clinic in NHS Fife.