Abstract
Aims
To describe how patients respond to early signs of foot problems and the factors that result in delays in care.
Methods
Semi-structured interviews were conducted with a large sample of Veterans from across the United States with diabetes mellitus who had undergone a toe amputation. Data were analyzed using inductive content analysis.
Results
We interviewed 61 male patients. Mean age was 66 years, 41% were married, and 37% had a high school education or less. The patient-level factors related to delayed care included: 1) not knowing something was wrong, 2) misinterpreting symptoms, 3) “sudden” and “unexpected” illness progression, and 4) competing priorities getting in the way of care-seeking. The system-level factors included: 5) asking patients to watch it, 6) difficulty getting the right type of care when needed, and 7) distance to care and other transportation barriers.
Conclusion
A confluence of patient factors (e.g., not examining their feet regularly or thoroughly and/or not acting quickly when they noticed something was wrong) and system factors (e.g., absence of a mechanism to support patient’s appraisal of symptoms, lack of access to timely and convenient-located appointments) delayed care. Identifying patient- and system-level interventions that can shorten or eliminate care delays could help reduce rates of limb loss.
Funder
U.S. Department of Veterans Affairs
Publisher
Public Library of Science (PLoS)
Reference34 articles.
1. Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008: Data Points #2;DJ Margolis;Data Points Publication Series,2011
2. Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations;TR Dillingham;Arch Phys Med Rehabil,2005
3. Amputation rates of the lower limb by amputation level—Observational study using German national hospital discharge data from 2005 to 2015;M Spoden;BMC Health Serv Res.,2019
4. Risk of ipsilateral reamputation following an incident toe amputation among U.S. Military veterans with diabetes, 2005–2016;AJ Littman;Diabetes Care,2020
Cited by
8 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献