Open AccessPodiatrist care and outcomes for patients with diabetes and foot ulcer
Author(s) -
Gibson Teresa B,
Driver Vickie R,
Wrobel James S,
Christina James R,
Bagalman Erin,
DeFrancis Roy,
Garoufalis Matthew G,
Carls Ginger S,
Gatwood Justin
Publication year - 2014
Publication title -
international wound journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.867
H-Index - 63
eISSN - 1742-481X
pISSN - 1742-4801
DOI - 10.1111/iwj.12021
Subject(s) - podiatrist , medicine , podiatry , amputation , logistic regression , hazard ratio , proportional hazards model , diabetes mellitus , foot (prosody) , diabetic foot , physical therapy , diabetic foot ulcer , propensity score matching , emergency medicine , surgery , confidence interval , complication , alternative medicine , linguistics , philosophy , pathology , endocrinology
We examined whether outcomes of care (amputation and hospitalisation) among patients with diabetes and foot ulcer differ between those who received pre‐ulcer care from podiatrists and those who did not. Adult patients with diabetes and a diagnosis of a diabetic foot ulcer were found in the MarketScan Databases, 2005–2008. Multivariate Cox proportional hazard models estimated the hazard of amputation and hospitalisation. Logistic regression estimated the likelihood of these events. Propensity score weighting and regression adjustment were used to adjust for potentially different characteristics of patients who did and did not receive podiatric care. The sample included 27 545 patients aged greater than 65+ years (Medicare‐eligible patients with employer‐sponsored supplemental insurance) and 20 208 patients aged lesser than 65 years (non Medicare‐eligible commercially insured patients). Care by podiatrists in the year prior to a diabetic foot ulcer was associated with a lower hazard of lower extremity amputation, major amputation and hospitalisations in both non Medicare‐eligible commercially insured and Medicare‐eligible patient populations. Systematic differences between patients with diabetes and foot ulcer, receiving and not receiving care from podiatrists were also observed; specifically, patients with diabetes receiving care from podiatrists tend to be older and sicker.