Technology-enabled remote management of diabetes foot disease and potential for reduction in associated health costs: a pilot study

Abstract

Diabetes-related foot disease, particularly when associated with amputation, affects quality of life and has a significant impact on health care costs. A pilot study using enhanced technology to facilitate remote access and video conferencing from rural locations to the diabetes MDT through a new service pathway confirmed high levels of patient satisfaction with 89% of foot ulcers improved or stable and only two minor amputations. A health economic analysis suggested potential for significant cost savings if this was scaled up regionally. Further evaluation of an integrated pathway, impact on lower limb amputation rates and full health economic assessment is recommended.

foot disease

Background

Diabetes foot ulceration can significantly impact quality of life and up to 20% of infected foot ulcers will require an amputation [1]. Furthermore, it has been recognised that a diabetes foot ulcer and a lower extremity amputation are independent risk factors for premature death [1]. Based on NHS England data It is estimated that more than £80 million is spent on foot ulcers and amputations annually in Scotland alone [2].  [READ MORE]

Methods

Two community podiatrists reviewed patients with diabetes foot ulcers in patients’ homes or local clinical settings in two defined rural areas over a six-month period using technology enabled care. A tablet device was used to capture images and, together with ‘Direct Access’ software, allowed remote access to a generic email account and clinical databases. An Omnirouter mini™ device aided connectivity through prioritisation of cellular networks. The tablet device was used for video-consultations, employing the NHS Near Me (Attend Anywhere) platform. This was facilitated by the community podiatrist with the patient in their own home. [READ MORE]

Results

Thirty-one patients were referred for specialist advice using the pathway. Following triage, there were 110 community-based podiatry visits (range 1–10 visits/patient), including 45 successful video-consultations with the MDT. The average home appointment time was 45 min, with actual VC times of 6–14 min. There were six failed VC connections due to technology problems. [READ MORE]

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