1 / 30

DIABETIC FOOT CARE IN BRAZIL: ACHIEVEMENTS AND CHALLENGES Dr Hermelinda Pedrosa Director

DIABETIC FOOT CARE IN BRAZIL: ACHIEVEMENTS AND CHALLENGES Dr Hermelinda Pedrosa Director Department of the Diabetic Foot Brazilian Diabetes Society. Diabetic Foot: Where we were ?. Diabetes National Programme Implementation - 1988. Targets: Set up basic diabetes teams:

axelle
Download Presentation

DIABETIC FOOT CARE IN BRAZIL: ACHIEVEMENTS AND CHALLENGES Dr Hermelinda Pedrosa Director

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DIABETIC FOOT CARE IN BRAZIL: ACHIEVEMENTS AND CHALLENGES Dr Hermelinda Pedrosa Director Department of the Diabetic Foot Brazilian Diabetes Society

  2. Diabetic Foot: Where we were ?

  3. Diabetes National ProgrammeImplementation - 1988 Targets: • Set up basic diabetes teams: primary /secondary care • Establish multidisciplinary teams: tertiary care - public hospitals Manual de Diabetes. Ministério da Saúde, 1990. ISBN 85-334-0031-4

  4. What about diabetic foot care ?

  5. 1990’s: depressing situation in Brazil • Low interest in foot problems • Diabetic foot care: restricted to surgical interventions (vascular, orthopedist) • Lack of specialist foot clinics • Scarce orthotics and foot material • High major amputation rates • No podiatrists Pedrosa HC et al. É possível salvar o pé diabético ? Arq Bras Endoc Metab, 1991. Spiechler E, Spiechler D, Forti AC, et al. OPAS Bulletin, 2001

  6. Hospital stay • UK and USA 25 - 21 days • International Consensus (average) 30 - 40 days • CEPEDF 60 – 90 days (Brasilia) IWGDF, 1999; Miziara MDY, Dias MSO, Farias L, Pedrosa HC, 1991

  7. Strategies:Save the Diabetic FootProjectimplementation

  8. Implementation • To set up a specialist foot clinic • To train health professionals on foot exam and care • To get the policymakers and hospital endocrine staff to understand the diabetic foot devastation • 1990´s – diabetic foot approach started to be linked to the hospital diabetes team

  9. Costs: the best approach to policy makers Ulcer and amputations (US $): • Ulcer + amputation 30,000-60,000 • Primary Ulcer 7,000-10,000 • Brazil-RS 7,000 2005 : R$ 16.000,00

  10. Setting up a foot team:Without a podiatrist – a remarkable barrier ?

  11. How to motivate professionals? foot workshops • Foot exam – screening techniques • Basic podiatry procedures • Ulcer management • Education – family, carers • Organization of care* • Prevention – Practical Guidelines* * Practical Guidelines – International Consensus, 1999. IWGDF – International Working Group on the Diabetic Foot

  12. Setting up a multidisciplinary team • Basic podiatry care: nurses join the project Berry BL, Black JA. What is chiropody / podiatry ? The Foot. 1992; 2: 59-60

  13. Basic foot kit:simple and affordable • Tuning fork, hammer, cotton wool, pin, monofilament, ecodoppler • Goniometer (physiotherapy staff)

  14. Neuropathic foot Foot exam: mandatory Ischaemic foot Neuroischaemic foot

  15. Organization of care Targets: • Primary care integration • Referral and contra referral system Hospital Specialist interdisciplinary team Health Centre Family health programme

  16. Achievements

  17. Sala Professor Andrew Boulton (new structure inauguration – 1999)

  18. Hospital Foot Team 1992 • Diabetologist • Nurses and Nurse Aid (Helpers) 2005 • Diabetologists / Medical residents • Nurses and Nurse Aid (Helpers) • Social Worker • Dietitians • Physiotherapists • Vascular Surgeons • Orthopaedist • Physiatrist • Orthotists • Dermatologist • Infectious Disease Specialist • Plastic Surgeon • Psychiatrist 02 13

  19. Major amputations (1992-2000) Trends towards reduction = 77% Note: Data - LEAS protocol and guidelines - data collection restricted to the reference hospital (Pedrosa HC et al. Diabetes Monitor, 2004)

  20. Amputation rate: according to level of procedure Note: Data - LEAS protocol and guidelines on data collection restricted to the reference hospital (Pedrosa HC et al. Diabetes Monitor, 2004)

  21. Insole provision: 1999-2004 Total = 5.141 Increase = 687.7%

  22. Workshops 37 Workshop attendees* 4.035 National Congress Regional Seminars 21 National Congress, Regional Seminars attendees** 4.950 Workshops and project demonstration: 1992/2005 mean attendance: workshop = 100; meetings = 200 total attendance estimated : 9.000 Ministry of Health, Brazíl; Brazilian Diabetes Society, Foot Department, 2005

  23. Brazilian version* XIII Brazilian Congress of Diabetes Rio de Janeiro, October 10-14th, 2001 * 4.000 issues

  24. Brazilian Diabetes Society Journal Diabetic Foot Forum* (*since 2001)

  25. The good news, the bad news: What are the challenges ?

  26. 2002 – 2005: main problems • PAD: late diagnosis confirmation • Revascularisation: scarce • Long hospital stay • Footwear: not available (yet) • Prosthetic provision: too late (6 months) • High amputation rates • No podiatrists yet

  27. Official Plans for 2005 - 2006 • Ministry of Health / SBD • Formation: Diabetic Foot Task Force Group* • Podiatry Course ? (US and UK support)* • Practical Guidelines – Primary Care • Basic care teams training: 4.000 (FHP**) • Outpatients Foot Clinics: improve structure • * Support: Ministry of Health – SBD; * IDF / WDF **Family Health Programme

  28. National Campaign – Logo:a sensibization approach Logo – Ministry of Health

More Related