LBSUN321 Development And Pilot Testing Of Barriers To Diabetic Foot Care With A Qualitative Assessment
Authors: Blanco Gerardo , Chirumamilla Siri , Rashied Ammar , Schechter Marcos Coutinho , Fayfam Maya 
Published: November 2022

Abstract

Objectives
Foot care is an essential component of diabetes care. We explored patient barriers to proper foot care in a disadvantaged population using surveys of patient perceptions on barriers and self-care.

Methods
Participants were recruited from an outpatient diabetes clinic at a safety-net hospital in Atlanta, Georgia from October 2021- January 2022 and stratified into two groups: 1) Complications defined as patient reported foot pain, history of foot ulcer or amputation and 2) No Complications defined as diabetes and no foot complications. A sample of 60 consecutive patients completed the surveys. The survey addressed patients’ experience in daily foot care and barriers to care. Survey data was supplemented by medical history information obtained from medical records. Based on the questions, a composite score was created for delay in care and missed appointments due to transportation challenges. Logistic regressions were utilized to perform univariate and multivariate assessments of delay in care and foot complications with stepwise adjustments for race, gender, age, employment, and education.

Results
Of the 60 participants, 41 (82%) had no reported foot complications and 11 (18%) reported foot complications. As compared to those without foot complication, those who had foot complications tended to be older (56.8 ± 10.2 years vs 60.4 ± 12.4), more often male (80% vs 40%), Black race (72% vs 94%), have diabetes for &gt;10 years (63% vs 37%) and be retired/unemployed (27%/27% vs 37%/30%). Those with complications tended to have lower education level (high school/GED education level (55% vs 43%) and lower employment status (37% vs 4%). Those with complications were more likely to have discussion regarding foot care with their health care provider (91% vs 74%) and less likely to miss an appointment due to transportation challenges (81% vs 49%). Those with complications were less likely to report the composite of delay in care or missed appointments (18% vs 59%). In the unadjusted regression model, delayed care was associated with 0.153 odds of having had foot related complications as compared to no complication (Confidence interval: 0. 03, 0.786). After adjusting for demographics age, race, and gender the likelihood of delayed care was 0.117 (CI: 0. 013, 1. 031) for those with complications as compared to those without complications. In the fully adjusted model, adjusting for demographics, education and employment status, the odds of delayed care was 0. 064 for those with complications as compared to those without (CI: 0. 004, 1. 003).

Conclusion
Based on our survey, transportation was identified as a barrier to access foot care. People without a history of foot complications were more likely to have delays in care and missed appointments. Avenues to improve access, especially early in the disease course, should be further explored within this patient population to assist with improving foot care.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.