The Hospital Admission Risk Program (HARP) Diabetes Foot Service (DFS) provides treatment of complex patients with advanced diabetes foot wounds to prevent hospitalisations and amputation. The multidisciplinary team identified the potential to enhance patients’ wound healing through increased identification of patients’ complex psychosocial issues. A pilot project was conducted to incorporate psycho-social screening of complex patients and referral to a dedicated care facilitator into the model of care.
Develop a tool to be used by podiatrists to identify patients’ psychosocial issues
Support podiatrists to incorporate discussion of psychosocial issues into therapeutic conversations
A pilot phase identified five key domains that contributed to the complexity of the patient group: mood, falls, career, services and housing. The “Five domains screening tool” was introduced into podiatry consultations. Podiatrists were coached to incorporate discussion of these issues in their therapeutic conversations and to normalize them in the context of clients’ chronic disease. Podiatrists referred patients identified to the care facilitator through a personal introduction, called a “warm handover”.
From September 2012 to February 2013, 25 patients were identified using the tool. Initially podiatrists expressed concerns about exploring psychosocial issues, however at the end of the project podiatrists reported increased confidence with their psychosocial assessment skills and the use of a “warm handover” resulted in more clients accepting services that were previously declined. The number of clients reviewed at case conference, the attention to clients’ psychosocial issues and the depth of case review and discussion was increased, as a result of other service improvements being made in the program at the time.
The Five Domains tool and associated professional development of podiatrists was successful in supporting DFS clinicians to incorporate assessment of patients’ psychosocial issues into their therapeutic conversations which in turn increased opportunities for clients to receive services to address these.