How do patients and healthcare professionals experience foot examinations in diabetes care? – a randomised controlled study of digital foot examinations versus traditional foot examinations

Abstract

Abstract Background: Digital solutions in healthcare can facilitate and improve care. However, the experiences and usefulness of using either digital foot examinations or traditional foot examinations need to be evaluated. The aims of the study were to evaluate: 1) the differences in patient experiences, having their foot examined supported by the Clinical Decision Support System (CDSS) as compared with having their foot examined in traditional practice, 2) how healthcare professionals (HCP), by using the CDSS, experienced the routine compared with performing the foot examination as in traditional practice. Methods Of a total of 141 patients, 100 patients with diabetes were single-blind digitally randomised to one of two parallel arms: having their foot examined by an HCP using a CDSS (n=47) or having their foot examined as in traditional practice (n=53) at the Department of Prosthetics and Orthotics at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients filled in a modified version of the National Patient Survey (NPS) and the Orthotics and Prosthetics Users’ Survey (OPUS) at study end. Two HCPs, working at a Department of Prosthetics and Orthotics, answered surveys regarding the interaction between the patient and the CPO. Results: Patients, aged 65±14 years, perceived a high level of satisfaction with the service at the department, regardless of the method used. No significant differences between groups were found when evaluated by 27 questions in the NPS or the OPUS, with scores of 67.17±12.18 vs. 66.35±16.52 (p=0.78) for the intervention and control group respectively. One hundred per cent of the patients were risk classified in the intervention group compared with 2% in the control group. Conclusions: Patients perceived a high level of satisfaction with the services at the DPO, regardless of the method used for the foot examination. All the patients were risk classified in the intervention group. The HCPs found that, by using the CDSS, the foot examination was structured and followed clinical guidelines. Furthermore, the documentation in the electronic health record was thorough, even though further improvements, such as integration with co-existing health record systems, were requested. Trial registration: Clinical Trials NCT03088566, Registered 23 March 2017, https://clinicaltrials.gov/ct2/show/NCT03088566?cond=d-foot&draw=2&rank=3