slide1
Download
Skip this Video
Download Presentation
DIABETIC FOOT CARE IN BRAZIL: ACHIEVEMENTS AND CHALLENGES Dr Hermelinda Pedrosa Director Department of the Diabetic Foot Brazilian Diabetes Society

Loading in 2 Seconds...

play fullscreen
1 / 30

Diabetes National Programme - PowerPoint PPT Presentation


  • 290 Views
  • Uploaded on

DIABETIC FOOT CARE IN BRAZIL: ACHIEVEMENTS AND CHALLENGES Dr Hermelinda Pedrosa Director Department of the Diabetic Foot Brazilian Diabetes Society. Diabetic Foot: Where we were ?. Diabetes National Programme Implementation - 1988. Targets: Set up basic diabetes teams:

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Diabetes National Programme' - LeeJohn


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

DIABETIC FOOT CARE IN BRAZIL: ACHIEVEMENTS AND CHALLENGES

Dr Hermelinda Pedrosa

Director

Department of the Diabetic Foot

Brazilian Diabetes Society

diabetes national programme implementation 1988
Diabetes National ProgrammeImplementation - 1988

Targets:

  • Set up basic diabetes teams:

primary /secondary care

  • Establish multidisciplinary teams:

tertiary care - public hospitals

Manual de Diabetes. Ministério da Saúde, 1990. ISBN 85-334-0031-4

1990 s depressing situation in brazil
1990’s: depressing situation in Brazil
  • Low interest in foot problems
  • Diabetic foot care: restricted to surgical interventions (vascular, orthopedist)
  • Lack of specialist foot clinics
  • Scarce orthotics and foot material
  • High major amputation rates
  • No podiatrists

Pedrosa HC et al. É possível salvar o pé diabético ? Arq Bras Endoc Metab, 1991.

Spiechler E, Spiechler D, Forti AC, et al. OPAS Bulletin, 2001

hospital stay
Hospital stay
  • UK and USA 25 - 21 days
  • International Consensus

(average) 30 - 40 days

  • CEPEDF 60 – 90 days

(Brasilia)

IWGDF, 1999; Miziara MDY, Dias MSO, Farias L, Pedrosa HC, 1991

implementation
Implementation
  • To set up a specialist foot clinic
  • To train health professionals on foot exam and care
  • To get the policymakers and hospital endocrine staff to understand the diabetic foot devastation
  • 1990´s – diabetic foot approach started to be linked to the hospital diabetes team
costs the best approach to policy makers
Costs: the best approach to policy makers

Ulcer and amputations (US $):

  • Ulcer + amputation 30,000-60,000
  • Primary Ulcer 7,000-10,000
  • Brazil-RS 7,000

2005 : R$ 16.000,00

how to motivate professionals foot workshops
How to motivate professionals? foot workshops
  • Foot exam – screening techniques
  • Basic podiatry procedures
  • Ulcer management
  • Education – family, carers
  • Organization of care*
  • Prevention – Practical Guidelines*

* Practical Guidelines – International Consensus, 1999. IWGDF – International Working Group on the Diabetic Foot

setting up a multidisciplinary team
Setting up a multidisciplinary team
  • Basic podiatry care: nurses join the project

Berry BL, Black JA. What is chiropody / podiatry ?

The Foot. 1992; 2: 59-60

basic foot kit simple and affordable
Basic foot kit:simple and affordable
  • Tuning fork, hammer, cotton wool, pin, monofilament, ecodoppler
  • Goniometer (physiotherapy staff)
slide14

Neuropathic foot

Foot exam:

mandatory

Ischaemic foot

Neuroischaemic foot

organization of care
Organization of care

Targets:

  • Primary care integration
  • Referral and contra referral system

Hospital

Specialist interdisciplinary team

Health Centre

Family health programme

slide17

Sala Professor Andrew Boulton

(new structure inauguration – 1999)

hospital foot team
Hospital Foot Team

1992

  • Diabetologist
  • Nurses and Nurse Aid (Helpers)

2005

  • Diabetologists / Medical residents
  • Nurses and Nurse Aid (Helpers)
  • Social Worker
  • Dietitians
  • Physiotherapists
  • Vascular Surgeons
  • Orthopaedist
  • Physiatrist
  • Orthotists
  • Dermatologist
  • Infectious Disease Specialist
  • Plastic Surgeon
  • Psychiatrist

02

13

major amputations 1992 2000
Major amputations (1992-2000)

Trends towards reduction = 77%

Note: Data - LEAS protocol and guidelines - data collection restricted to the reference hospital (Pedrosa HC et al. Diabetes Monitor, 2004)

slide20

Amputation rate:

according to level of procedure

Note: Data - LEAS protocol and guidelines on data collection restricted to the reference hospital (Pedrosa HC et al. Diabetes Monitor, 2004)

insole provision 1999 2004
Insole provision: 1999-2004

Total = 5.141 Increase = 687.7%

workshops and project demonstration 1992 2005

Workshops

37

Workshop attendees*

4.035

National Congress

Regional Seminars

21

National Congress, Regional Seminars attendees**

4.950

Workshops and project demonstration: 1992/2005

mean attendance: workshop = 100; meetings = 200

total attendance estimated : 9.000

Ministry of Health, Brazíl; Brazilian Diabetes Society,

Foot Department, 2005

slide25

Brazilian version*

XIII Brazilian Congress of Diabetes

Rio de Janeiro,

October

10-14th, 2001

* 4.000 issues

slide26

Brazilian Diabetes Society Journal

Diabetic Foot Forum*

(*since 2001)

2002 2005 main problems
2002 – 2005: main problems
  • PAD: late diagnosis confirmation
  • Revascularisation: scarce
  • Long hospital stay
  • Footwear: not available (yet)
  • Prosthetic provision: too late

(6 months)

  • High amputation rates
  • No podiatrists yet
slide29

Official Plans for 2005 - 2006

  • Ministry of Health / SBD
  • Formation: Diabetic Foot Task Force Group*
  • Podiatry Course ? (US and UK support)*
  • Practical Guidelines – Primary Care
  • Basic care teams training: 4.000 (FHP**)
  • Outpatients Foot Clinics: improve structure
  • * Support: Ministry of Health – SBD; * IDF / WDF

**Family Health Programme

ad