For people with diabetes, minor injuries (such as cuts and bruises) and stress fractures can rapidly progress to ulcers, infections and amputation. Foot ulceration is one of the leading causes of hospitalisation for people with diabetes.
WNSWLHD is geographically the largest local health district (LHD) in NSW. At 246,676 square kilometres, it covers 31% of NSW and provides healthcare to a population of over 278,759. Like many rural and remote regions in NSW, WNSWLHD experiences significant challenges in employing a specialist rural workforce to support the health needs of its communities. High risk foot clinicians are highly specialised: there are a limited number of podiatrists employed within NSW Health and just one high risk foot skilled podiatrist in WNSWLHD.
Providing care close to home and on country
The WNSWLHD HRFS was established in 2018 as an outpatient service at Dubbo Base Hospital. The HRFS provides specialised, multidisciplinary management of diabetes-related foot conditions to people living across WNSWLHD.
In 2019 the HRFS began delivering virtual services to the northern sector of the LHD. These services are critical to improving access for those living in these remote regions of the district. The HRFS is also an important service offering for Aboriginal people in the region, as 13% of the population of the WNSWLHD identify as Aboriginal or Torres Strait Islander. Rates of diabetes related foot amputations are much higher in Aboriginal people (53.9 per 100,000 populations) than in non-Aboriginal people (12.7 per 100,000 populations)† . The Dubbo HRFS aims to deliver appropriate and culturally responsive care for Aboriginal people.
Building relationships and mutual respect
In establishing the service, the HRFS senior podiatrist worked on the ground at rural facilities to identify and build relationships with key staff to support consults.
Over time, relationships have been developed with services and health service managers to ensure appropriate support at the patient end. These relationships are built on mutual respect between clinicians at both ends of the consultation.
The HRFS senior podiatrist travelled to several sites and presented on the scope and benefits of the service. This assisted with clinician buy-in to the service.
The service used patient reported experience measures (PREMs) to understand the patient’s experience of accessing care in the HRFS. PREMs are used alongside other data collected to identify opportunities to improve the service.
Award winning virtual service
Since establishing virtual services in 2019, the HRFS has saved patients from travelling over 74, 000kms to access care in Dubbo or at an in-person outreach clinic.
Through access to the HRFS (both in person and virtual):
- the number of serious (transmetatarsal, above knee, and below knee amputations) reduced to zero in 2019/2020
- less serious amputations of the toe (without amputating metatarsal bone) have increased from five to nine in line with the decrease in serious amputations
- foot conditions are being identified and appropriately managed earlier, resulting in better patient outcomes (see graph below).
16% of all occasions of service in the 2020/21 year were virtual, an increase from 5% in 2018/2019.
The service was awarded the WNSWLHD Quality Keeping People Healthy Award in 2020.