INTRODUCING THE DIABETIC FOOT ASSESSMENT FORM ON MMEX (E-HEALTH PLATFORM)

1. INTRODUCING THE DIABETIC FOOT ASSESSMENT FORM ON MMEX (E-HEALTH PLATFORM) 31st October 2013 Audrey Xie, BPodM Podiatrist e: audreyzxie@gmail.com

2. BACKGROUND – MMEX1 • E-health platform • Provided by the UWA Center for Software Practice

3. BACKGROUND – MMEX1 • Pros: • Small annual fee of $250 (FREE for Department of Health) • Ease of use – patient notes, alerts, reminders, calendar • No physical storage • Attachment of photos, documents, letters, forms • Secure database • Safe and confidential communication with health professionals and hospitals (including tertiary hospitals) • Cons: • Not all health professionals in the Wheatbelt are aware of it or are using it

4. A KEY CHALLENGE – FOOT ULCERS • Foot ulcers can be detrimental

5. STATISTICS & FIGURES • Cost to the patient and the health department • 5-year mortality rates for diabetes amputations are 50% (twice that of cancer)2 • Each amputation costs $26,000 to the health department2 • An area for improvement – it can be achieved

6. NATIONAL EVIDENCE-BASED GUIDELINES: PREVENTION • “85% of diabetes amputations are entirely preventable”3 • Identify patient’s risk • “Assess all people with diabetes and stratify their risk of developing foot complications”4 • Regular foot assessments • “Any suitably trained healthcare professional may perform the risk assessment”4

7. NATIONAL EVIDENCE-BASED GUIDELINES: MANAGEMENT • “Pressure reduction optimises healing of foot ulcers”4 • “People with diabetes-related foot ulceration are best managed by a multi-disciplinary foot care team”4 • Deep ulcers (probe to tendon/bone) • 4 weeks’ duration • Absence of foot pulses • Ascending cellulitis • Suspected Charcot’s neuroarthropathy

8. USING THE DIABETIC FOOT ASSESSMENT FORM ON MMEX • Formulated by Deborah Schoen • Universal form for all diabetic foot assessments • Evidence-based • Available on MMEx for all users • Able to attach completed forms to patient record • Easy to use & risk is automatically calculated • 5 essential components • Current foot ulcer • History of amputation/foot ulcer • Foot deformity • Palpation of foot pulses • Presence of protective sensation

9. 1. CURRENT FOOT ULCER2. HISTORY OF AMPUTATION/FOOT ULCER If any “Yes” is checked, patient is immediately classified as High Risk

10. 3. FOOT DEFORMITY If 3 or more “Yes”, patient is considered to have a foot deformity

11. 4. PALPATION OF FOOT PULSES If 3 or more “+” , patient is considered to have palpable foot pulses

12. 5. PRESENCE OF PROTECTIVE SENSATION As long as 1 site is “-”, patient is considered to have no protective sensation

13. RISK FACTOR 6 months 12 months 3 months

14. CONCLUSION • As a primary health professional, you can help to: • Identify ulcer risk • Conduct a foot check every 3/6/12 months • Encourage pressure relief • Refer to Podiatrist or multidisciplinary foot care team

15. TAKE-HOME MESSAGE • “A foot ulcer is serious…”3 – help to prevent it!

16. REFERENCES • UWA CSP. MMEx [Internet]. Perth, WA (Australia): MMEx; 2013 [updated 2013 Aug 21; cited 2013 Oct 20]. Available from: http://www.mmex.net.au • Australasian Podiatry Council. Diabetic Amputations in Australia. Brunswick East (VIC): Australasian Podiatry Council; 2013 Oct. • 85 per cent of diabetes amputations "entirely preventable”. Diabetes WA [Internet]. 2012 Aug 31 [cited 2013 Oct 20]; Diabetes WA News. Available from: http://www.diabeteswa.com.au/News_and_events/Diabetes_WA_News/News_Details/85_per_cent_of_diabetes_amputations • National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications: Part of the Guidelines on the management of Type 2 Diabetes [Internet]. Melbourne: National Health and Medical Research Council; 2011 [cited 2013 Oct 20]. Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/diabetes_foot_full_guideline_23062011.pdf