Catalyst Grant Feature- Reducing Health Inequities and Access Barriers in Severe Diabetic Foot Infection and Amputation by Engaging At-Risk Communities to Optimize the Implementation of Evidence-Based Strategies

Project Objective: Further optimize the implementation of evidence-based strategies (multidisciplinary team and care pathways) in the care of diabetic foot ulcers to prevent severe outcomes and reduce health inequities.

With a goal of lessening access barriers for people living with diabetes who develop foot ulcers, Dr. Terence Tang’s Catalyst Grant project also aims to reduce the rates of severe infection and amputation.

For people living with diabetes, foot ulcers are a common complication caused by changes in their blood vessels and nerves. Good foot care is essential to ensuring feet remain healthy and foot ulcers don’t develop, or are treated quickly if they do appear. “Sometimes, despite their best efforts, people run into trouble with infections and they become severe, sometimes they have to undergo amputation of a part of the foot or leg to ensure infection doesn’t spread,” explains Tang.  “We know from other studies that there are ways we can care for patients living with diabetes and foot ulcers to prevent amputation as a complication.”

One important factor for successful interventions is having a multidisciplinary team helping to manage a person’s diabetes, foot care and other health concerns. When healthcare teams are working collectively, it is more likely they will be able to diagnose and treat foot ulcers early and effectively.

Tang, who works for Trillium Health Partners in Mississauga, knows that in Peel Region a major barrier to this type of care is access to services—and that the social determinants of health can be a complicating factor. “For someone with a foot ulcer, getting to appointments could be challenging. If your foot hurts, you may not be able to drive or you can’t walk or take the bus. Even though the service is available, it may be very challenging to access if you don’t have supports,” he says. “And to treat the ulcer you can’t put pressure on it—that would prevent the injury from healing. There are specialized boots, but those are expensive if you don’t have insurance coverage. There are options for people who don’t have insurance, but accessing those may be challenging. And if you have to go to work and your job doesn’t allow you to stay off your feet, that can be a problem too.”

Working with the community in Peel to understand all of the potential barriers to accessing care will help healthcare providers tailor solutions that meet the needs of those at risk of amputations. In his Catalyst Grant project, Tang and his team are assessing interventions that have been tried before to address access barriers and looking at what has been successful in other regions. So far, they have screened more than 10,000 abstracts and are in the process of narrowing down that list.

They have also started phase two, where they are conducting interviews with clinicians, nurses, allied health, and people with lived experience of amputation or diabetic foot infections in Peel Region. These discussions will help them understand the specific circumstances individuals are managing and the local healthcare landscape.

In the third part of the study, they will bring together those from the medical sector with community and social services to address the access challenges identified. The goal is to co-design better services or improve the way existing services are delivered so that the barriers to effective care are reduced. 

So far, the team has had the challenges they suspected going into the project validated and learned that once people arrive at the hospital care is appropriate and supports are provided. It’s in the community that resources are challenging, which can negatively impact early interventions. Tang hopes they can use this information to focus in on locally-relevant solutions during phase three.

“A lot of healthcare services are oriented around clinicians,” he says, noting that timing of appointments is one such example. Getting transportation, taking time off work, finding someone to take you to the clinic can be difficult if appointments are only available during the day. “Just because the services are there doesn't mean people can access them or use them. It's absolutely critical that the process works for the people who need to use these services.”