Objectives & approach
The rising burden of diabetes in the wake of rapid economic transition and urbanisation in China is beginning to stretch the health system. Many of the affected people are in great risk of developing complications like foot problems simply due to poor knowledge, lack of access to care and presence of other associated risks such as obesity and high tobacco and alcohol consumption which worsen nerve damage (neuropathy) and poor circulation. As a consequence, simple wounds do not heal and turn into chronic infected wounds. In worst case scenario a minor wound can result in amputation of the foot and leg and ultimately it can even cause premature death.
Apart from ignorance among people with diabetes, poor management of wounds and foot ulcers by health care professionals with limited knowledge of proper wound care techniques often leads to chronic wounds, requiring prolonged hospitalisation at high costs. Due to a rapid increase in diabetes in China, it is becoming increasingly difficult for the health care system to cope with the rising numbers of people with foot problems. In addition to diabetes, chronic wounds can be caused by other problems such as prolonged immobilisation, which can result in bed sores - wounds that are equally difficult to manage. Training of HCP at the primary care level in wound care is scarce and therefore many HCP do not have the necessary knowledge and training in foot care; hence there is an urgent need to educate doctors and nurses in this area.
The main objective is to improve diabetic foot care by training health personnel and create awareness about proper care and treatment of wounds first to prevent them from becoming chronic non healing wounds and secondly on how to manage these wounds so that they do not result in limb loss or other major disability.
The Chinese Tissue Repair Society (CTRS) is implementing this first project in China with focus on diabetic foot ulcers with support from the World Diabetes Foundation and co-support from Coloplast A/S.
The project is a national wound care program that seeks to reach out to all areas of China. Training will take place in 5 different hospitals each year in order to cover as many areas as possible during the 3 years. The training will initiate in Beijing, Zhejiang, Shannxi, Guangdong and Jiangsu and subsequently continue in smaller areas of China. However, students from smaller cities will be invited to participate the first year in the bigger cities. Each hospital will conduct two workshops yearly and each workshop will educate approximately 60 HCP.
Training will commence with a two day lecture, continue with a half day of practical experience and finalise with a paper prepared by the student over a case study from their local hospital. Lectures will be given by experts within the field who will teach the students in modern techniques and concepts of wound care.
Upon completion of the training, the trained health personnel are expected to provide training to other HCP in their respective hospitals and thereby increase the number of wound care specialists in addition to providing care for people with chronic wounds.
In order to improve awareness for proper treatment and care of chronic wounds, the newly trained personnel will give presentations and equip patients with material about diabetes. This will increase the knowledge of diabetes and improve the adherence to the treatment prescribed.
After project completion, the CTRS will continue the training of doctors and nurses in the hospitals. The training will be financed by the students' enrollment fees.
• 60 workshops conducted in 3 years
• 3,600 doctors and nurses trained through the workshops
• 3,600 patients have benefitted
Results at completion:
- 60 workshops conducted
- 9,229 HCSs trained
- 4,900 patients benefitted
- Wound care teams established at 42 hospitals
- 9,092 diabetes patients screened for diabetic foot
- 1,209 feet saved