Mr Marcus Gardner1, Mr Adam McLean1, Dr Byron Perrin2
1Bendigo Health, Bendigo, Australia, 2La Trobe Rural Health School, Bendigo, Australia
Diabetes-related foot disease causes significant morbidity and those in rural areas are disproportionately affected. Total contact casts (TCC) or walkers made irremovable (iTCC) are the gold standard for managing neuropathic foot ulceration but are under-utilised, particularly in rural areas. The aim of this study was to evaluate a podiatrist-led service model (“PodCast”) for providing TCCs and iTCCs in a rural and regional setting.
A mixed methods evaluation approach was used over a 12 month period. Outcome measures included: number of TCC/iTCCs provided; number of patients treated; wound healing data; and service cost. Qualitative measures included a focus group with podiatrists to explore service implementation barriers and enablers.
There was a two-fold increase in the number of TCCs/iTCCs provided and the number of patients treated, although demand at the rural site was lower than predicted. Average time to wound healing was 50 days (n = 13; s.d. 39). Costs with providing the service were similar to those associated with outsourcing the service. Workforce enablers identified included using more iTCCs as a simpler and cheaper alternative to TCCs and barriers included unpredictable demand in rural sites.
Significance of findings to allied health:
PodCast increased access to TCCs and iTCCs for patients in this rural and regional setting and healing times were comparable to other reported studies. Increased use of iTCCs made the service model more efficient and cost effective while providing similar outcomes to TCCs. This finding may inform the development of services in other rural and regional settings.
Marcus Gardner is Manager of Podiatry and Allied Health Education and Research at Bendigo Health and a PhD candidate with the La Trobe Rural Health School.