Wednesday, July 11, 2007
This presentation is part of : Chronic Illness Strategies
Outcomes of a Nurse-Managed Diabetic Foot Clinic
Darlene Mary Gilcreast, RN, PhD, MSN, CDE1, Beverly Sue Rose, MSN2, Janet F. Stansberry, MSN3, Debra D. Mark, PhD4, and Paul C. Lewis, PhD3. (1) School of Nursing, Chronic Care Nursing Department, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA, (2) Family Medicine Service, Brooke Army Medical Center, San Antonio, TX, USA, (3) Nursing Research Service, Brooke Army Medical Center, San Antonio, TX, USA, (4) Nursing Research Service, Tripler Army Medical Center, Honolulu, HI, USA
Learning Objective #1: Describe nursing interventions to promote diabetic preventive foot care.
Learning Objective #2: Describe the impact of nurse-managed foot care on occurrence of foot lesions in patients with diabetes.

Aims/Objectives:  To determine whether a nurse-managed diabetic foot clinic will decrease lesions, improve overall health, and reduce healthcare costs for patients with diabetes.

 Framework: The Chronic Disease Model defines outcomes based on the patient, healthcare system, and support systems. Incidence of foot wounds with diabetes is approximately 15% with 7 per 1,000 progressing to amputation/year at $30,000 each. Reduced productivity and quality of life are significant with wounds or amputation.

 Research Design: An experimental randomized, controlled design enrolled 128 adults with diabetes for 1 year who were at high risk or very high risk for foot wounds. Dependent variables were: lesion rates, health status, and healthcare costs. Treatment was well-foot care (nails trimmed, calluses filed, pressure off-loading, and wound care) plus education. The control group received education only. Each visit, participants received foot assessment. High-risk feet in the treatment group were seen every 3 months and very-high-risk feet were seen every 2 months. Control participants were seen every three months regardless of category. Control participants were referred to healthcare providers if needed. The Medical Outcomes Study Short Form-36 was completed at enrollment and the end of 1 year. A patient satisfaction survey was done at the end. A 1-year healthcare utilization survey was completed and times of visits were measured to calculate costs.

 Data Analysis: Z-tests, chi-square, and t-tests were used.

 Study Findings: Fewer lesions occurred on visit 1 in treatment participants than control although not statistically significant (10 vs. 13; chi square  = 0.820, p=0.636). At visit 5, 18.7% more lesions occurred in control than treatment participants (12 vs. 8, statistically significant chi square  =4.385, p=0.034). There were a mean 8.4% fewer lesions in the treatment group overall demonstrating effectiveness of nursing interventions to prevent foot wounds.