Many patients with diabetic foot infections (DFI) face challenges with keeping their follow up appointments. This can result in recurrent DFI. A joint, Infectious Diseases- Podiatry clinic (JIDPC) that an Infectious Diseases (ID) physician and a Podiatrist see their patients together in wound care center once a week, was initiated in January, 2017. This study was designed to investigate if JIDPC can improve patient compliance and outcomes.
A retrospective analysis of the patients admitted to Wheeling Hospital with DFI from March, 2013 to December, 2017 and required post discharge follow up by ID and Podiatry was performed. Initially, they were followed by ID and Podiatry in their clinics separately (pre-intervention group). Beginning January, 2017, they were followed together at the JIDPC (post-intervention group). Recurrent infection, mortality and lost to follow-up were compared between the two groups using logistic regression models adjusting for age and sex.
Among 119 patients, 85 patients were in pre- and 34 patients were in post-intervention group. Surgeries were performed in 47.1% of pre-intervention group and 85.3% of post-intervention group (p< 0.001) (Table 1). Risk of recurrence in 6 months was significantly higher in pre-intervention group (Odds ratio (OR)=3.14[1.07, 9.24]), but with further adjustment for surgery, p-value was 0.05 (OR=3.08[0.98-9.62]). Pre-intervention group was more likely to be lost to follow-up (OR=3.67[1.16-11.59]) but the association was attenuated with further adjustment for surgery (OR=2.17[0.64-7.41]). Re-admission in 90 days and mortality rate were not significantly different.
Implementation of JIDPC would be effective to decrease the incidence of recurrent infections among DFI.
Table 1. Clinical Characteristics and Comparison Between Pre and Post Intervention Groups
|Characteristic||Pre-intervention Group (n=85)||Post-intervention Group (n=34)||P Value|
|Peripheral Vascular Disease||28||33.0||11||32.4||0.859|
|Poorly Controlled Diabetes||37||43.5||14||41.2||0.815|
|Lost Follow Up||27||31.8||4||11.8||0.025|
|Recurrent Infection in 6 months||31||36.5||5||16.7||0.044|
T. Fujii, None