Foot care and footwear training, Thailand

Objectives

The diabetes prevalence in Thailand is 7.75% (IDF, 2011). According to the project partner, it is estimated that 50% of lower extremity amputation, excluding accidents, is due to diabetes. Many existing diabetic wounds and amputations lead to high medical expenses, loss of productivity, and lower quality of life. Most amputations due to diabetes complications are preventable through rather simple preventive measures and treatment.

The lack of knowledge and experience of local healthcare professionals on the diabetic foot ulcers causes a subsequent lack of awareness, lack of prevention, and improper primary foot care and referrals. Podiatry training in Thailand does not yet exist, and there is no formal education for specialists in diabetic foot and wound care. Existing orthopedtics in Thailand still focus on prosthetic rather than preventive footwear.

Thailand’s first diabetes center was started in 1993 in Theptarin Hospital. In 2007, the World Diabetes Foundation funded the project WDF07-279, which was Thailand’s first effort for mass training of foot care professionals. The project was continued under WDF09-413. It became apparent that teams that have attended the trainings during these projects have initiated work on foot care in their own facilities. They now require more knowledge, wound care management skills, and toolkits to continue the progress that was initiated during the above mentioned projects.

In late 2008, the Thai Association of Diabetes Educators started to include basic foot care training into their annual routine training schedule. In 2011, footwear for diabetic foot ulcer prevention was included on the National Health Security Organization (NHSO) reimbursement list. However, NHSO has faced unexpectedly high cost of footwear due to a lack of knowledge. Footwear training has the potential to demonstrate to NHSO how footwear reimbursements should be handled.

The goal of this project is to expand foot care capacity by increasing access to quality diabetic foot care in Thailand.

Approach

Four activities that support the project objectives will be arranged: 1) Advanced diabetic foot and wound care training, 2) Knowledge Management Forum, 3) Footwear modification shop, and 4) Educational tool.

Two eight-day advanced diabetic foot and wound care training sessions will be arranged each year for four years at Theptarin Hospital in Bangkok. The training sessions will target multidisciplinary health care professionals (HCPs) with experience in foot care. The trainings will include lectures, workshops, and case discussions. Each team will be given a starter kit with tools and educational material to establish foot care facilities in their local area. A total of 400 participants will be trained over the four year period. Follow-up visits to the trained participants’ local clinics will be arranged by the project partner.

A foot and wound care session will be set up at the existing annual Diabetes Knowledge Management Forum to allow the trained participants to share their clinical experiences with the relevant stakeholders. The Forum is organized by a network of people working with diabetes with support from the National Health Security Organization, the Diabetes Educators Association, Walailuck University, and the Foundation for the Development of Diabetes Care.

A footwear modification shop will be set up at the Theptarin Hospital to help foot clinic staff and footwear technicians get acquainted with machines and tools, while preparing them to be the next generation of foot care trainers.

As part of this project, Thailand’s first book on diabetic foot and wound care will be written and published by a team of nationally-known experts. 1,000 copies will be published. In addition, 4,000 sets of posters, pamphlets, and DVDs on foot care will be produced and distributed. This formal knowledge sharing will help create foot care awareness and understanding beyond those that will be trained.

Results at completion

• 8 CHAI health facilities strengthened with diabetes care.
• 8 doctors, 7 nurses and 25 paramedical staff from 8 CHAI health facilities trained in 5 days in diabetes prevention and management.
• 1,374 people with diabetes referred for treatment at CHAI member hospitals.
• 26 health camps for the general population conducted.
• 12 special awareness programmes conducted.
• 22,183 people screened for diabetes.
• 231,342 people sensitised on diabetes.
• 583 women screened for GDM and sensitised on GDM through health camps for pregnant women.
• 8 CHAI health facilities strengthened with GDM care.
• 10,000 people recieved foot care