Abstract
OBJECTIVES: To identify areas of improvement in diabetic foot care as regards the availability of materials and specialties in primary and secondary care. To determine the model of care for surgical centres and hospitals caring for diabetic foot problems and their relation to amputations. DESIGN: Cross-sectional study SETTING AND PARTICIPANTS: Random sample of 36 basic health areas (BHA) and all hospital surgery centres in Catalonia (Spain). MEASUREMENTS: Information was collected by structured interview of managers of each centre on: availability of specialists, material off-loading and examination. The models were established according to the classification of Van Acker, and amputations from hospital discharge records. RESULTS: An endocrinologist was available in 36.1% [confidence interval (CI) 95%:19.0-53.2] of the BHA and 11.1% [95% CI: 3.1-26.1] had a podiatrist,100% [95% CI: 90.3-100.0] had Doppler, 91.7% [95% CI:77.5-98.2] a monofilament, 5.6% [95% CI: 0.7-18.7] a quantitative tuning fork, 11.1% [95% CI:3,1-26, 1] material off-loading, and 8.3% [95% CI: 1.8 - 22.5] a specialist reference centre. A total of 85 surgical centres and hospitals dealt with these problems: 11(13.0%) excellent model, 29 (34.1%) intermediate and 45 (52.9%) basic/insufficient. Centres with a basic model/insufficient performed 12.5% of the amputation, intermediate models, 56.4%, and 31.1% in excellent models. CONCLUSIONS: The proportion of ABS with materials, specialists and/or specialist reference centres was low. The basic/insufficient model was the most common among surgical/hospital centres. Most amputations were performed in centres with excellent and intermediate model; nevertheless, a considerable percentage was performed in centres with basic/insufficient models.