One Foot at a Time: Building a Healthy Community Through Diabetes Education and Foot Care in Appalachia

Topic:  Each week over 1,400 lower limbs are amputated on adult diabetics.  Remote Area Medical (RAM) clinics are often the only opportunity for comprehensive preventative health care for the people of Appalachia.  A team of WOC nurses partnering with a pharmacist provided rural underserved patients with comprehensive diabetes foot care.

 

Purpose: To provide comprehensive interventional diabetic foot care, education, and supplies to a remote and underserved population in rural Virginia. 

 

Objectives

This innovative program included specialized diabetic foot assessments and interventions.  Care included ABI measurements, X-rays, orthotic fittings, and diabetic socks with referral to a roving community health van for follow up.

The program had a three-fold purpose: First, that comprehensive diabetic foot care would be provided.  Second, teach back -education on 3 specific points of importance of diabetic foot care were taught pre-treatment and post treatment patients were evaluated by requested teach back for retention and comprehension of foot care.  Third, that follow-up appointments would be scheduled when possible by local free community clinic staff with the uninsured, rural, and transient population treated at Remote RAM clinic.

 

Outcomes;

54 patients were treated in two days: All patients had toenails trimmed and callouses removed.  One patient with a chronic wound was treated.  23% of patients had tinea pedis, and 39% had onychomycosis.  All patients received 3 point education, and all patients were able to independently demonstrate back 1 of 3 points.  All received supplies ranging from topical ointments, to diabetic socks and diabetic shoes.  In addition three non-diabetic patients with Charcot foot were identified, x-rayed, and treated.  All patients that lived within driving distance were scheduled follow up appointments with a NP at a community free clinic.  Through the RAM clinic underserved patients received needed comprehensive foot care.