High-risk foot clinic boosts outcomes

Diabetes-related foot disease (DFD) refers to sequelae (an after-effect of a disease, condition or injury) – such as ulcers and amputation – from diabetes-related peripheral neuropathy (damage to nerves outside of the brain and spinal cord), peripheral vascular disease (reduced circulation to parts of the body) and foot deformity.

The disease remains a major health concern in Gippsland, in regional Victoria. But an ongoing collaboration between Latrobe Community Health Service (LCHS) and Latrobe Regional Hospital (LRH) is boosting access to DFD care across the region, with its community model of care spawning outcomes on par with similar services in metropolitan Melbourne.

Around 50,000 people live with DFD in Australia today, with 12,500 people living with diabetes-related amputations. People in regional and remote Australia are up to 11 times more likely to have their toes or feet amputated due to DFD. The Gippsland Primary Health Network (PHN) has the second highest prevalence of diabetes among all PHNs in Australia, with 63 per 1,000 people having the disease, according to Diabetes Australia’s 2015 Australian Diabetes Map. To date, there is no research on the prevalence and outcomes of DFD in Gippsland, with a comprehensive multidisciplinary high-risk foot service formerly lacking in the region.

In response, LCHS and LRH joined forces in November 2022 to establish the Gippsland High Risk Foot Clinic (GHRFC) – a collaborative high-risk foot service and the first ever joint clinic to collect data on DFD presentations and outcomes in the region.

Using data generated since the clinic’s establishment, a prospective audit of the first six months of patient records was conducted. We aimed to evaluate the effectiveness of implementing a collaborative inpatient and community model of care to address the issue of DFD, by examining the healing rates of diabetes-related foot ulcers over a 12-week period.

In the first six months of service, the GHRFC treated 84 DFD patients who presented with 129 ulcerations. Patients had multiple morbidities, with approximately 60 per cent having hypertension and dyslipidaemia, among other medical conditions. The healing rate for diabetes-related foot ulcers after 12 weeks was 35 per cent, equivalent to that of major tertiary centres in Melbourne. Before presenting to the GHRFC, patients were found to have had their ulcer for 39 days on average. However, patients in Melbourne presented to a doctor only 14 days after ulcer formation.

Our data shows that, although healing rates for diabetes-related foot ulcers are similar, patients at the GHRFC generally take longer to present themselves compared to similar services in Melbourne. This highlights the need for further outreach in the Gippsland community to ensure shorter referral times, which may reduce healing times further.

Data also revealed that only six per cent of patients were of Aboriginal and Torres Strait Islander descent. The GHRFC is committed to improving high-risk foot care for this portion of the population, who are 38 times more likely to develop DFD. Earlier this year, the team delivered an outreach clinic in Bairnsdale at the Gippsland & East Gippsland Aboriginal Co-operative (GEGAC).

‘Patient attendance is improved because they are able to come to an environment that’s familiar to them,’ says Sophie Ljujic, Health Services Coordinator at GEGAC. ‘The care pathways at the GHRFC mean travel to Melbourne is not always necessary, ensuring better health outcomes for members of our Indigenous community.’

The establishment of the GHRFC shows that a collaborative inpatient and community model of care between independent organisations may be one effective solution to better manage the burden of health diseases, such as DFD, in regional communities with limited access to health care.

‘The major benefit of our partnership with LCHS is that patients can now receive a continuity of specialised care – closer to home – between acute and community services,’ says Alison Lang, High Risk Foot Coordinator at GHRFC.

For more information about the high-risk foot service or to make a referral to the GHRFC, please contact [email protected]