Diabetic foot: Care networks, Peru

Objectives

Studies of the prevalence of diabetes in Peru (PERUDIAB) have determined it is 7.0% for the country as a whole, but in Lima it is as high as 8.4%. With these data, it is estimated that in absolute figures there are around one million people with diabetes in Peru, and if we bear in mind that some 46% of people are undiagnosed, we can infer that there are around 2 million people affected by the disease.

Objectives
To create Networks in clinics at different health care levels in the La Libertad and Lambayeque regions
Creation and implementation of foot clinics
To strengthen the specific skills, according to health care level, of doctors and nurses
To evaluate the performance of beneficiary clinics
To raise awareness of diabetes and diabetic foot

Approach

Establishment of four networks (one EsSalud and one MoH network in each targeted region) through the establishment of a technical committee; including referral mechanisms on diabetic foot care involving advanced, intermediate and basic health facilities.
Provision of upgraded foot care equipment to 30 health facilities (two advanced, five intermediate and 23 basic).
Development and implementation of guidelines for diabetic foot care at intermediate and advanced care levels.
Training of doctors and nurses in advanced diabetic foot care and surgery through workshops and courses; for advanced care level international trainers from the region will be involved as these skills are not available in Peru.
Training of surgeons in limb saving surgery and advanced wound care.
Establishment of a skills development center for diabetic foot care.
Establishment of a comprehensive monitoring and evaluation system for the involved clinics and registered patients; including clinical indicators.
Implementation of various communication strategies for increased awareness on diabetes and diabetic foot for early detection.

Results at completion

29 clinics upgraded and included in four networks in two regions (18 MoH clinics and 11 EsSalud clinics).
Guidelines for basic level foot care refined and endorsed by authorities.
Guidelines for foot care at intermediate and advanced care levels developed and endorsed by authorities.
40 doctors (GPs) and 45 nurses with updated and advanced knowledge about basic foot care (basic and intermediate level).
45 nurses trained in interactive education and basic foot care (basic and intermediate level).
12 surgeons (three general, six traumatologists and three cardiovascular surgeons) trained in limb saving surgery and advanced wound care (intermediate and advanced level).
35 nurses trained in advanced wound care (intermediate and advanced level).
6,982 patients registered and evaluated for diabetic foot.
2,853 patients trained in self-management of diabetic foot care.
19 people with diabetic foot deformities have undergone surgery.
62 patients with wounds have feet saved.
160 patients in advanced wound healing.
600,000 reached through awareness activities (mass media).