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    Prevention and Early Intervention for Diabetes Foot Problems

    5. Provider and Patient Education continued...

    Patients should never be allowed to walk on open plantar ulcers since continuous application of mechanical load will prevent healing. Walking aids, footwear modifications, or other interventions must be used to relieve weight23.

    A pilot program for African Americans consisted of a 15-minute orientation meeting between a diabetes nurse educator and the person with diabetes, a take-home foot self-care packet, and a follow-up telephone interview. During the telephone interviews, subjects reported that the most useful parts of the take-home packet were the patient instruction booklet, the large hand mirror included in the packet, and the foot care knowledge self-test with explanations of the answers. Subjects also valued the reminder cue that was repeated in bold face on each page of the booklet telling them to call the doctor immediately if any cut, bruise, or blister does not begin to heal after one day24.

    Step-by-step guidelines have been published to assist providers to conduct patient education workshops on foot care including how to attract participants, promote the workshop, develop the agenda, identify appropriate speakers, and conduct a post-workshop evaluation25.

    6. Clinical Issues

    Provider Foot Care Practices

    In a study of provider practice, researchers found that clinicians were likely to prescribe preventive foot care behaviors when they were aware of a patient's high risk for LEA as evidenced by prior history of foot ulcer. Clinician awareness of two other risk factors (peripheral neuropathy or peripheral vascular disease), however, did not increase preventive care practices. The researchers concluded that physicians and patients need periodic reminders to identify patients in all high-risk categories for ulcer or amputation and to provide additional care such as podiatric visits and education in self-care10.

    A study of nurse practitioner practice patterns was conducted to determine their consistency with the American Diabetes Association (ADA) standards of care. An audit of 78 medical records representing a proportionate number for each of six masters-prepared, certified nurse practitioners revealed discrepancies between established standards and the degree to which they were documented. Comprehensive foot care examinations (required annually by ADA standards) were documented in 23 percent of the charts reviewed26.

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