Improving foot care for people with diabetes mellitus - a randomized controlled trial of an integrated cave approach

Aims To evaluate a model of integrated diabetic footcare, for identificatio n and clinical management of the high risk diabetic foot, centred on the pr imary care-based diabetic annual review. Methods A pragmatic randomized controlled study was undertaken with matched cluster randomization of practices from 10 towns drawn from mid and east D evon responsible for the care of 1939 people with diabetes (age greater tha n or equal to 18 years). Outcome measures were patients' attitudes regardin g the value and importance of footcare, patients' footcare knowledge, healt hcare professionals' footcare knowledge and pattern of service utilization. Results Attitudes towards footcare improved in both intervention and contro l groups (mean percentage change 3,91, 0.68) with a significant difference in change of 3.18 (95% confidence interval (CI) 1.29-5.07) between the grou ps. Patients' knowledge about diabetic foot problems improved significantly in both groups (mean percentage change 1.09, 1.32) but with no significant difference in change: -0.09 (95% CI -1.81-1.63) between groups. Health pro fessionals' knowledge scores improved in the intervention group (mean perce ntage change 13.2; P < 0.001). No improvement was seen in the control group (mean percentage change -0.2; P = 0.1) with a significant difference in ch ange of 13.46 (95% CI 8.30_18.62) between groups. Appropriate referrals fro m intervention practices to the specialized foot clinic rose significantly (P = 0.05) compared with control practices (P = 0.14). Conclusions Provision of integrated care arrangements for the diabetic foot has a positive impact on primary care staffs' knowledge and patients' atti tudes resulting in an increased number of appropriate referrals to acute sp ecialist services.