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Community Foot Care Service: A Pioneer Multi-disciplinary Partnership Program for Elderly Foot Care. Symposium on Community Engagement II 23 September, 2006 . Patrick NG BSc(Hons) MMedSc Podiatrist-in-charge St. James’ Settlement. Background.

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Community Foot Care Service: A Pioneer Multi-disciplinary Partnership Program for Elderly Foot Care

Symposium on Community Engagement II

23 September, 2006

Patrick NG

BSc(Hons) MMedSc

Podiatrist-in-charge

St. James’ Settlement


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Background

  • Foot problems are affecting one in three community-dwelling elderly (Barr et. al., 2004), and associated with poor mobility, increased frequency of fall, and functional deterioration in elderly (Dawson et. al, 2002).

  • Elderly considers foot pain an inevitable consequence of aging rather than a medical problem (Menz & Lord, 2001). Garrow et al. (2004) reported 84% of patients neglect the foot problem.

  • Chinese population exhibits a higher threshold of perception of symptoms of foot condition (Chan & Chong, 2002).



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Ambulation

may be the only dividing line between institutionalisation and remaining an active member of the society.



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Community Foot Care Service

  • A pilot project - the collaboration between St. James’ Settlement and Hong Kong East Clusters’ hospitals.

  • Focus on enhancing foot care to the poor and socially deprived elderly, who is unable to take care of their own foot health.


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Objectives

  • To provide accessible podiatric care to the community dwelling home or institute bound elderly.

  • To maintain post hospital discharged high risk patients and minimises unplanned readmission and ulcer recurrence rate.

  • To reduce the demand on HA hospital podiatry service.


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Algorithm of Referral

Community Referrals

chronic foot problem for palliative care

acute and subacute foot diseases

Exacerbated

HKEC Hospitals for podiatric care

Community Foot Care Team

  • Prevention

  • Maintenance

When high risk foot stabilised then discharge.

Discharge





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Case Illustration I

F/84, renal impairment, dementia & CVA with R hemi.

Knee extension padding

28.6.2006

8.9.2006

11.5.2006


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Case Illustration II

Special design for Malleolus

Protector

Pressure Sore on Lateral Malleolus of Right Foot


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Highlights of the Program

  • Strength: being mobile and out-reaching, provides on-site team approached foot management.

  • Limitation: only 1 podiatrist and 0.5 PT & 0.5 OT to provide service.

  • Future development: the same service model could roll out to other clusters if resources is available.

  • Sustainability: this program is supported by a charity donation, a long term commitment is essential.


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Conclusions

  • This pilot program is an example of hospital-community and multi-disciplinary collaboration.

  • The Community Foot Care Service has improved the general foot condition of the institutional bound elderly by increased accessibility to podiatric care, one-stop multi-disciplinary referral, and shortened waiting time.

  • Prevention and maintenance of chronic medical conditions in the community are relatively low cost but can contribute significantly towards the reduction of overall health care expanses.

  • More emphasis and attention as well as resources should be available at the community level to promote early prevention and care, in view of our aging society.


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Who would you want to SEE?Who would you want to BE?

Thank You


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