Determining the patient-perceived impact of foot health education for patients with diabetes mellitus

Abstract

The impact of foot problems in diabetes on the National Health Service (NHS) is extremely large, accounting for 10% of the entire NHS budget for England and Wales (Global Diabetes Community, 2015). The annual NHS spend on diabetes is predicted to rise from £9.8 billion currently to £16.9 billion by 2035 (Diabetes UK, 2012). The NHS (2011) commissioned a report which cited patient education as a key factor in the overall care package of optimum diabetic foot management. Indeed, patient education in diabetes mellitus is viewed as a vital part of a patient-centred care philosophy which is a pillar of the Diabetes National Service Framework (DoH and Diabetes UK, 2005). So much so, that National Institute of Clinical Excellence [NICE] (2009) list patient education as a key target for diabetes management with structured education programmes to be delivered at the point of diagnosis with annual reinforcement and review. However, what is not clear from many studies in this area is the patients perceptions of the education that they received and what impact they feel that this has had on their management of diabetes particularly in relation to their foot health. This study looked to determine the patient-perceived impact of foot health education for patients with diabetes mellitus via a qualitative methodology. 20 participants who have type 1 or type 2 diabetes mellitus who fit the inclusion criteria were randomly selected and invited for in-depth semi structured interviews relating to their experience of patient education in diabetes mellitus, with a focus on their foot health. The results of this study indicate that the individuals interviewed had a very inconsistent patient education experience, particularly in relation to their foot health with a large proportion of these individuals not receiving services in line with national commissioning reports and guidelines. This was most notably identified with almost half of all participants interviewed indicating that they received no patient education whatsoever, with those that did receive structured patient education not having this education reinforced annually. Furthermore, where patient education pertaining to foot health was received by individuals, the patient-perceived impacts of this education were varied and did not demonstrably lead to a sustained change in foot health perception or behaviours.