A foot injury can quickly escalate to loss of limb or a life-threatening situation for a person living with diabetes. Every two hours a person with diabetes has a lower limb removed as a direct results of diabetes related foot disease, yet 80% of these amputations are preventable. A 2017 study shows the total cost of high-risk foot (HRF) hospital admissions in Western Australia was $150 million in 2015 and from 2003 to 2015 HRF hospital admissions have increased by 60%. The same report identified that out of the 14 Perth metro regions, the Balga-Mirrabooka area has the highest number of HRF admissions, higher amputation rates and poor access to foot services.
To address these concerns, WA Primary Health Alliance (WAPHA) partnered with Diabetes WA in collaboration with Sir Charles Gairdner Hospital Multi-Disciplinary Foot Unit (SCGH MDFU) to capture the lived experience of people with diabetes related foot disease and their health professionals to inform future initiatives. On 22 April, an event was held to share the findings from the first phase of the project. Almost 80 health care professionals from a variety of fields gathered to explore and understand the factors contributing to the high amputation rates of people with diabetes within the North Metropolitan region of Perth. The event was held at the University Club of Western Australia and sponsored by Boston Scientific and Urgo Medical. Podiatrists, nurses, general practitioners (GPs), health planners and various specialists came together to listen to consumer feedback identifying the need for improved shared care, communication and integration of services across different levels of the WA health system.
Diabetes WA’s Credentialled Diabetes Educator and Registered Nurse, Shona Vigus who coordinated the project and event, worked closely with Dr Robert Ma, Dr Mendel Baba and Dr Madison Champion from the SCGH MDFU on an extensive consultation process. The consultation entailed interviewing 25 people with diabetes and 52 Health Care Professionals (HCPs) from a wide range of disciplines and settings, including SCGH, General Practice, Silver Chain, Joondalup Hospital and Moorditj Djena. This provided incredible insight into the obstacles and barriers experienced by people with high-risk feet when accessing care. The qualitative data from the interviews were presented at the event in the hope of inspiring a collaborative approach to finding solutions.
Shona mentioned one of the event highlights was the presentation of the north-metropolitan specific ‘Risk stratification and Active Foot Disease’ referral pathways clarifying the eligibility criteria and timeframes for referring people with diabetes on to services. While this was the first step in understanding areas to improve to better provide timely access to foot care, urgent solutions are still required for people with high-risk feet to receive the right care, at the right time, in the right place.
“The challenge now for the WA Primary Health Alliance funded project is to engage a wider group of North Metropolitan based HCPs to foster collaborative solutions for timely intervention to reduce amputations and achieve positive outcomes for people with diabetes,” Shona said. “Better engagement from GPs in the Balga-Mirrabooka area is probably our biggest challenge right now.”
Diabetes WA continues to keep diabetes and feet on the agenda through other planned events where these project results will also be presented. The WA Foot Collaborative Annual Meeting, ‘Time is Tissue’ will be held on 26 June at Fiona Stanley Hospital with leading specialists in footcare sharing their work around innovative and integrated models of care. Reserve your spot at this event to learn more about the North Metropolitan Foot Initiative project and HRF recurring barriers to care. If you are a Health Care Professional and would like to attend, get in touch with Jennifer Sweeting to register — email@example.com or for more information call 1300 001 880.
 Study: High Risk Foot: Geographical Inequities, Importance of Different Diagnosis Groups Forecast Hospitalisations, and Access to Services. (Tuson, Kok, Yap, Turlach, Vickery, Whyatt; 2017)  The conference at UWA was sponsored by Boston Scientific and Urgo Medical  The WA Primary Health Alliance (WAPHA) funded the qualitative study and project – North Metropolitan Foot Initiative