Background
Diabetic foot ulcers (DFU) are increasingly prevalent, and associated with significant morbidity, mortality, and cost. An interprofessional approach to DFU management is critical given the etiological complexity involved.

Aim
This study aimed to assess the impact of an interprofessional team approach on DFU diagnosis and management.

Method
A retrospective cohort study of patients attending a large regional community care centre (CCC) between February 11, 2013-May 11, 2014 was conducted. Following referral from the CCC, patients were assessed by an interprofessional wound care team (IWCT), and those aged > 18 years with a DFU of > 6 weeks duration were included. The primary outcomes were the accuracy and precision of the initial diagnosis. Secondary outcomes included wound healing, and infection parameters. Analysis was done with STATA 13.1 (College Stn., TX) of pre-determined outcomes with 2 sided α of 0.05.

Results
49 patients (67.3% male) of mean age 64.2 years (SD 13.7) diagnosed with chronic DFU by an IWCT were included. Accuracy of initial diagnosis was 81.6% (95% CI: 70.8%-92.5%). Of these, 95% were referred as unspecified DFU, and were reclassified to a precise diagnosis relating to etiology including neuropathy, and ischemia following IWCT (p < 0.001). For secondary outcomes following IWCT, healability assessment was conducted for a greater proportion of patients (55% versus 100%, p < 0.001). Dressing change frequency decreased significantly following IWCT assessment (pre: 4.31/week; post: 3.54/week; p = 0.03). Improvements were also demonstrated in pain and quality of life measures (p < 0.05).

Discussion
49 patients (67.3% male) of mean age 64.2 years (SD 13.7) diagnosed with chronic DFU by an IWCT were included. Accuracy of initial diagnosis was 81.6% (95% CI: 70.8%-92.5%). Of these, 95% were referred as unspecified DFU, and were reclassified to a precise diagnosis relating to etiology including neuropathy, and ischemia following IWCT (p < 0.001). For secondary outcomes following IWCT, healability assessment was conducted for a greater proportion of patients (55% versus 100%, p < 0.001). Dressing change frequency decreased significantly following IWCT assessment (pre: 4.31/week; post: 3.54/week; p = 0.03). Improvements were also demonstrated in pain and quality of life measures (p < 0.05).

Exploring models of care in diabetic foot ulcer management: a cohort study