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2006 HSR&D National Meeting Abstract

3076 — Identifying Foot Care Needs in Diverse High-Risk Veterans

Author List:
Raugi GJ (VA Puget Sound)
Reiber GE (VA Puget Sound)
Rajan M (VHA East Orange NJ)
Pogach L (VHA East Orange NJ)

To identify knowledge and satisfaction with foot care among diverse veterans with high-risk foot conditions.

We identified 1836 patients at high risk for diabetic foot complications at 8 VA Medical Centers and administered a patient foot care survey. Of this group 5% were deceased, 5% had unclear diagnoses or incomplete surveys, leaving a final sample of 772 or 44.1%.

Respondents were 81% White, 13% African American, 4% Asian, and 2% other. In this chronically ill population, two-thirds of participants rated their general health as fair or poor. When asked about routine self-care for their feet, respondents fell well short of VA benchmarks. On a daily basis, only 30% inspected their feet, 55% washed their feet, 31% checked the water temperature before immersing their feet, 50% dried between their toes, and 32% checked their shoes for rough edges or foreign objects. Even worse, 38% walked barefoot or in stockings inside their house. Foot self-care performance was highest in the Asian population. When queried about what they recalled having ever been taught about 7 aspects of foot self-care, only 27%-63% indicated that they had “enough” knowledge, while 5%-42% indicated they knew “nothing at all.” Patients identified the most significant barrier to reaching the goal of regular self-care was inability to comfortably reach their feet (36%). Half the patients felt that their foot care providers did not involve them enough in making decisions about their foot care and 72% felt that there were services needed for their foot care that were not being received. The problems were greater across minority groups compared to whites.

Despite enormous efforts and expense on the part of the Department of Veterans Affairs to educate patients with diabetes about foot complications, results from this survey demonstrated significant gaps between expectations and reality. These gaps were wider in minority than in white patients.

These results indicate that the education and care paradigm we have been working with is inadequate to address the problem. We propose that a patient-centered care approach consistent with the Chronic Care Model be utilized to monitor both unmet care needs and the quality of educational instruction offered to diverse veterans with diabetes and high risk feet.

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