A Service Evaluation of a Diabetic Foot Protection Service: Patients’ Experiences and Views

Background: Diabetes is an increasingly widespread long-term illness that places a life changing burden on individuals. Foot complications, as a result of diabetes, require a significant amount of healthcare intervention and resource. If not treated effectively foot complications can lead to active foot disease and lower limb amputations which cause disability and suffering. The aim of this service evaluation was to investigate the experiences of people using a new Foot Protection Service (FPS), established in Leeds in 2016, and use the findings to explore ways in which the FPS can be improved.

Methods: One-to-one interviews were conducted with a purposive sample of individuals, who were at either moderate or high risk of foot ulceration as a result of diabetes, and had used the FPS. Thematic analysis was used to identify, analyse, code and describe patterns within the data.

Results: Seventeen patients who had used the FPS participated in the study. Five key themes were identified: The mechanisms adopted for referral into the FPS and missed opportunities for care, the impact of the FPS as a source of support, increased awareness around self-care, patient views about the service and the accessibility of the FPS. The identification of these themes led to the development of recommendations to support the service in identifying areas for improvement.

Conclusion: Health professionals responsible for referring 'at risk' patients need to be fully aware of the risks of a person with diabetes presenting with foot problems, and how to refer to the FPS for assessment. The wider social circumstances of patients should be taken into consideration by Diabetes Specialist Podiatrists (DSPs) to provide effective support whilst patients adjust to this potentially life changing complication, tailoring education and advice to their individual needs. Understanding experience health care services is an invaluable tool in developing quality improvement strategies.