Recursos y modelos de atención al pie diabético en Cataluña (España): estudio descriptivo sobre espacios de mejora / Resources and models for diabetic foot care in Catalonia (Spain): A descriptive study on areas of improvement

Objetivos: Identificar espacios de mejora en la atención al pie diabético relacionados con la disponibilidad de materiales y especialidades en atención primaria y secundaria. Determinar el modelo asistencial de los centros quirúrgicos/hospitalarios que atienden problemas del pie diabético y su relación con las amputaciones realizadas. Diseño: Estudio transversal. Emplazamiento y participantes: Muestra aleatoria de 36 áreas básicas de salud (ABS) y el total de centros quirúrgicos/hospitalarios de Cataluña (España). Mediciones principales: Información recogida mediante entrevista estructurada a los responsables de cada centro sobre: disponibilidad de especialistas, material para descargas y exploración. Los modelos se establecieron según la clasificación de Van Acker y las amputaciones según el registro de altas hospitalarias. Resultados: Un 36,1% [intervalo de confianza (IC) del 95%:19,0-53,2] de las ABS disponían de endocrinólogo y un 11,1% [IC del 95%:3,1-26,1] de podólogo. El 100% [IC del 95%:90,3-100,0] tenían doppler, el 91,7% [IC del 95%:77,5-98,2] monofilamento, el 5,6% [IC del 95%:0,7-18,7] diapasón con escala graduada, el 11,1% [IC del 95%:3,1-26,1] material de descarga y el 8,3% [IC del 95%:1,8-22,5] un centro de referencia especializado. Un total de 85 centros quirúrgicos/hospitalarios atendían estos problemas: 11 (13,0%) modelo excelente, 29 (34,1%) intermedio y 45 (52,9%) básico/insuficiente. Un 12,5% de las amputaciones se realizaron en centros con modelo básico/insuficiente, un 56,4% en intermedio y un 31,1% en excelente. Conclusiones: La proporción de ABS con materiales, especialistas y/o centros de referencia especializados, fue baja. Entre los centros quirúrgicos/hospitalarios, el modelo básico/insuficiente era el más frecuente. La mayoría de las amputaciones se realizaban en centros con modelo excelente e intermedio; no obstante, un porcentaje considerable se practicaban en centros con modelos básico/insuficiente(AU)

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(AU)

[Resources and models for diabetic foot care in Catalonia (Spain): a descriptive study on areas of improvement]. / Recursos y modelos de atención al pie diabético en Cataluña (España): estudio descriptivo sobre espacios de mejora.

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.