Colombia has been facing challenges in expanding and improving the quality of the public health system. In addition, the estimated prevalence of diabetes of 7,1% (IDF Atlas 2013) and its related complications present an increasing heavy socio-economic burden for the country.The Department of Córdoba has no comprehensive diabetes prevention programmes and some of the municipalities are located in remote areas, which make timely access to care even more difficult. Complications such as diabetic foot ulcers have escalated due to the low quality of primary care, lack of resources, education initiatives and comprehensive management. Only 33% of the patients at risk in Córdoba have had their feet screened and a large number of patients go untreated, resulting in many needless amputations. The objective is to promote prevention, early detection and provide proper treatment of the diabetes foot ulcers at 20 selected primary health care centres in the department of Córdoba, Colombia.
The Health Secretariat, University of Córdoba, Ministry of Health and other entities will support this particular initiative. In order to reach the objective, the following activities will be conducted:1. The guide developed by the Colombian Diabetic Foot Group (Colpedis) for diagnosis and treatment of the diabetic foot will be adopted. A committee will be formed to update and revise the guideline to achieve a consensus for primary care of the diabetic foot. The San Elián classification used in the management of patient with the diabetic foot will be adopted as well. This will improve patient safety and will facilitate doctors’ treatment decisions. This activity will be carried out by a committee who will share the information developed in the sessions on a website.2. Health care professionals (HCP) will receive training in prevention, diagnosis and treatment of the diabetic foot. The Colpedis guide and the manual of updated processes will be used in the training program. The aim is to improve the continuing training of HCPs, to be implemented subsequently in the health centres across the region. Workshops will be held on how to work as a team and a training manual will be developed. After training of the staff, an educational intervention will be made through campaigns to educate the population on risk factors of the diabetic foot and prevention of complications.3. Diabetic foot primary care units will be established in 20 primary care centres in the Department of Córdoba. The centres will be equipped with a basic kit for clinical assessment of the diabetic foot. A screening and management algorithm will be implemented to ensure that a consistent treatment is conducted throughout the health centres. 4. 250 people with diabetes will participate in the trainer of trainers (ToT) program. Theoretical and practical workshops in foot self-care will be conducted for people with diabetes living in rural zones and areas of difficult access. They will be responsible for transferring their knowledge to other patients and making timely referrals of patients with lesions or ulcers to primary care centres. At the end of the activity, an educational foot care booklet containing “best practices” will be designed and the impact generated by the ToTs in the community will be evaluated.5. Finally, a mobile unit for treatment of the diabetic foot problems will be set up. This activity will make access to treatment more readily available in areas of difficult access.
- 150 health care providers in primary healthcare centers were trained.- 250 patients trained as trainers of trainers in foot self-care.- 20 diabetic foot primary care units established.- Screening of 3 000 patients with diabetes mellitus for diabetic foot risk factors in the Department of Córdoba- Awareness of diabetes care and the risk of diabetic foot raised in 10 000 people with diabetes and their companions.