Pre‐hospital delay in patients with diabetic foot problems: influencing factors and subsequent quality of care

Aims To assess pre‐hospital patient delay and its associated variables in patients with diabetic foot problems. Methods We classified 270 patients with diabetic foot problems retrospectively based on the distribution of pre‐hospital delay. Clinical, demographic and socio‐economic data were collected. Logistic regression analysis was performed to examine independent associations with patient delay. Results The median pre‐hospital delay time was 46.49 days. Patients reported short (≤ 1 week; 77 patients, 28.5%), moderate (> 1 week and ≤ 1 month; 106 patients, 39.3%) and long delays (> 1 month; 87 patients, 32.2%). In a univariate analysis, nine variables were associated with a longer delay ( P  < 0.05): (1) no previous ulcer; (2) no health insurance; (3) poor housing conditions; (4) low income level; (5) low educational level; (6) infrequent foot inspection; (7) few follow‐up medical visits; (8) absence of diabetic foot education; (9) lack of knowledge of foot lesion warning signals. A multivariate analysis showed that absence of diabetic foot education (odds ratio 2.70, 95%  CI 1.03–7.06, P  = 0.043) and lack of knowledge of foot lesion warning signals (odds ratio 2.14, 95%  CI 1.16–3.94, P  = 0.015) were independent predictors of long patient delay. Long delay increased the risk of amputation (odds ratio 2.22, 95%  CI 1.36–3.64, P  = 0.002) and mortality (odds ratio 2.69, 95%  CI 1.35–5.33, P  = 0.005). Conclusions A number of factors were involved in pre‐hospital delay among patients with diabetic foot problems and contributed to poor outcomes. We recommend developing a community intervention programme that targets at‐risk communities to encourage earlier multidisciplinary team assessment to reduce disparities and improve foot outcomes in patients with diabetes.