EVALUATION OF A DIABETIC FOOT SCREENING AND PROTECTION PROGRAM

We set out to evaluate a clinical foot-screening programme in terms of primary outcomes (reductions in the incidence of ulcers and lower lim b amputation) and process outcomes (compliance with screening, the num ber of patients not completing the programme and the use of chiropody services and prescribed footwear and cost). All but 4 of 2001 patients attending a general diabetic out-patient clinic were allocated random ly to index and control groups, The exceptions were patients who prese nted with active ulcers and were placed in the index group. Primary an d secondary screening programmes identified 128 high risk patients in the index group and these were admitted to the foot protection program me. At 2-year follow-up, 11 fewer ulcers were reported from the index group. There were 7 amputations (1 major, 6 minor) in the index group and 23 (12 major and 13 minor) in the control group. The differences w ere not statistically significant for ulceration or minor amputations but significant for major amputations (p < 0.01). The total cost of th e 2-year programme was pound 100 372 (1991-92 costs), with a mean cost per patient of approximately pound 100. Taking pound 12 000 as a cons ervative estimate of the cost of a major amputation, the foot clinic w as cost-effective in terms of amputations averted, The process outcome s were much less satisfactory. Cast-effectiveness could have been impr oved if it had been possible to improve patient compliance. (C) 1998 J ohn Wiley & Sons, Ltd.