...........................................................................................................................i Dedication ..................................................................................................................... iii Acknowledgments .......................................................................................................... iv Table of

How Do Health Care Providers Identify and Address Lifestyle Factors with Community Dwelling Adults Who Have Chronic Wounds

Incidence of amputation secondary to diabetic foot disease is unacceptably high, especially as up to 80% of these amputations are deemed preventable through optimal management and education. Tackling complications and reducing amputation rates requires a holistic approach identifying issues at a person, system and population level. Investing in preventive strategies is cost effective and avoids the burden of extremely costly reactive interventions. The overarching aim of this thesis was to understand the previously undocumented burden of diabetes-related amputation and the associated risk factors for amputation within Wales. The thesis investigated amputation rates and mortality in the Welsh population with and without diabetes over the last decade for both major and minor amputations using a repository of medical data of all Welsh residents. The thesis also examined risk factors for amputation at a person, health board and population level using different methodologies to quantify specific risks. This included root cause analysis to assess care provision and questionnaires to understand patient’s knowledge and behaviours. The thesis identified variance from gold standards of care for diabetic foot disease and most amputations in the root cause analysis were determined potentially preventable. However, it identified simple behavioural and educational measures and areas for implementation of risk reduction strategies within our health board. Despite the population with diabetes representing only 7% of the total Welsh population, they accounted for over 50% of the incident amputations performed. Only a minor reduction in rate of amputation was seen over time and there was marked variance in rates between health boards. Mortality following major amputation was high with a mortality rate of 61.9% at 5 years in the total population and 67% in the population with diabetes. By highlighting variance and current trends in care the thesis provides the grounds for the implementation of interventions to reduce amputation rates. 

Prevention of Major Amputation secondary to Diabetes-related Foot Disease

To date, there has been little psychological research in the diabetic foot population. In this short article, it is argued that there is a strong and urgent need for increased psychological focus. Insights from a psychology pilot study are drawn upon, which tested an intervention aimed at increasing patient involvement in foot treatment decisions and facilitating shared decision making (McBride et al, 2016). The psychological complexities of patients who present to the diabetic foot clinic are discussed, along with pragmatic suggestions for future research into the behavioural elements of diabetic foot care.

Patient engagement with diabetic foot care: a psychological perspective

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Patient engagement with diabetic foot care: a psychological perspective