2 型糖尿病患者和脚部手术伤口：对初级保健医生的过度信任、孤独感以及对未来的担忧。

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2024-10-18 DOI:10.1016/j.diabres.2024.111861

Judith Charbit , Marie-Laure Gbessoua , Juliette Jacquot , Nathalie Garnier , Veronique Labbe Gentils , Meriem Sal , Narimane Berkane , Sopio Tatulashvili , Emmanuel Cosson , Hélène Bihan

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引用次数: 0

摘要

目的：在欧洲，27%的糖尿病足并发症患者在病情发展超过 3 个月后会被转到专业机构接受手术治疗。我们的研究旨在分析严重糖尿病足患者获得医疗服务的情况和未来的自我规划：方法：我们通过半结构式访谈对住院的需要手术治疗的糖尿病足患者进行了定性研究。我们收集了有关糖尿病特征、社会不稳定程度、焦虑和抑郁的定量数据：我们共进行了 13 次访谈，访谈对象为 2 名女性和 11 名男性，平均年龄为 62.7 岁。其中五人接受过手术清创，六人截趾，两人跗骨中段截肢。大多数人的社会经济状况不佳和/或与世隔绝。讨论中出现了三个主题：1）护理路径的异质性，存在系统性障碍、疏忽或过度信任；2）社会支持与预测未来的能力之间的关系；3）语言贫乏：教育应强调伤口发生后及时转诊到专业机构的重要性。缺乏亲人的支持和社会支持似乎与患者未能规划自己的未来有关。我们主张对所有这些患者进行心理评估并提供支持。

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Patients with type 2 diabetes and surgical foot wounds: Overtrust in primary care physicians, isolation, and difficulties contemplating the future

Aims

In Europe, 27 % of patients with a podiatric complication of diabetes are referred to a specialized structure for surgery after more than 3 months’ disease progression. Our study aimed to analyze access to healthcare and future self-projection in patients with severe diabetic foot conditions.

Methods

We performed a qualitative study with semi-structured interviews in patients hospitalized with diabetic foot conditions requiring surgical treatment. We collected quantitative data on the diabetes characteristics, levels of social precariousness, anxiety and depression.

Results

We conducted 13 interviews with 2 females and 11 males; mean age 62.7 years. Five had undergone surgical debridement, six toe amputation, and two mid-tarsal amputation. Most were socioeconomically deprived and/or isolated. Three discourse themes emerged: 1) heterogeneity in the care pathway, with systemic barriers, negligence or overtrust 2) relationship between social support and the ability to project oneself into the future, 3) poverty of speech.

Conclusions

Education should emphasize the importance of prompt referral to a specialized structure after the onset of a wound. The lack of support from loved ones and social support appeared to be associated with patients’ failure to plan for their future. We advocate for a psychological evaluation and support for all these patients.

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.