Community Foot Care Service: Community Foot Care Service:

A Pioneer Multi-disciplinary Partnership A Pioneer Multi-disciplinary Partnership Program for Elderly Foot CareProgram for Elderly Foot Care

Patrick NG BSc(Hons) MMedSc BSc(Hons) MMedSc Podiatrist-in-chargePodiatrist-in-chargeSt. James’ SettlementSt. James’ Settlement

Symposium on Community Engagement II

23 September, 2006

BackgroundBackground

Foot problems are affecting one in three community-dwelFoot problems are affecting one in three community-dwelling elderly (Barr et. al., 2004), and associated with poor ling elderly (Barr et. al., 2004), and associated with poor mobility, increased frequency of fall, and functional deterimobility, increased frequency of fall, and functional deterioration in elderly (Dawson et. al, 2002). oration in elderly (Dawson et. al, 2002).

Elderly considers foot pain an inevitable consequence of Elderly considers foot pain an inevitable consequence of aging rather than a medical problem (Menz & Lord, 200aging rather than a medical problem (Menz & Lord, 2001). Garrow et al. (2004) reported 84% of patients neglect 1). Garrow et al. (2004) reported 84% of patients neglect the foot problem.the foot problem.

Chinese population exhibits a higher threshold of perceptChinese population exhibits a higher threshold of perception of symptoms of foot condition (Chan & Chong, 2002). ion of symptoms of foot condition (Chan & Chong, 2002).

Bound FeetBound Feet

AmbulationAmbulation

may be the only dividing line between institutimay be the only dividing line between institutionalisation and remaining an active member onalisation and remaining an active member

of the society.of the society.

Hidden Hidden BombsBombs

Community Foot Care ServiceCommunity Foot Care Service

A pilot project - the collaboration between A pilot project - the collaboration between St. James’ Settlement and St. James’ Settlement and Hong Kong East Clusters’ hospitals.Hong Kong East Clusters’ hospitals.

Focus on enhancing foot care to the poor Focus on enhancing foot care to the poor and socially deprived elderly, who is and socially deprived elderly, who is unable to take care of their own foot unable to take care of their own foot health.health.

ObjectivesObjectives

To provide accessible podiatric care to the comTo provide accessible podiatric care to the community dwelling home or institute bound elderly. munity dwelling home or institute bound elderly.

To maintain post hospital discharged high risk pTo maintain post hospital discharged high risk patients and minimises unplanned readmission anatients and minimises unplanned readmission and ulcer recurrence rate. d ulcer recurrence rate.

To reduce the demand on HA hospital podiatry sTo reduce the demand on HA hospital podiatry service.ervice.

Community Referrals

HKEC Hospitals for podiatric care

•Prevention

•Maintenance

Community Foot Care Team

Algorithm of ReferralAlgorithm of Referral

Exacerbated

Discharge

acute and subacute foot diseases

When high risk foot stabilised the

n discharge.

chronic foot problem for palliative care

Sources of ReferralsSources of Referrals

Old Age Home Foot Profile (1)Old Age Home Foot Profile (1)

Old Age Home Foot Profile (2)Old Age Home Foot Profile (2)

Other findingsOther findings %%

Improper caring of toe nailsImproper caring of toe nails 6464

Foot problem result from Foot problem result from neglected self foot careneglected self foot care

4141

Case Illustration ICase Illustration I

Knee extension padding

F/84, renal impairment, dementia & CVA with R hemi.

11.5.2006 28.6.2006 8.9.2006

Case Illustration IICase Illustration II

Pressure Sore on Lateral Malleolus of Right Foot

Special design for MalleolusProtector

Highlights of the ProgramHighlights of the ProgramStrength:Strength: being mobile and out-reaching, provides being mobile and out-reaching, provides on-site team approached foot management. on-site team approached foot management.

Limitation:Limitation: only 1 podiatrist and 0.5 PT & 0.5 OT to only 1 podiatrist and 0.5 PT & 0.5 OT to provide service. provide service.

Future development:Future development: the same service model could the same service model could roll out to other clusters if resources is available. roll out to other clusters if resources is available.

Sustainability:Sustainability: this program is supported by a this program is supported by a charity donation, a long term commitment is charity donation, a long term commitment is essential. essential.

ConclusionsConclusionsThis pilot program is an example of hospital-community This pilot program is an example of hospital-community and multi-disciplinary collaboration.and multi-disciplinary collaboration.

The Community Foot Care Service has improved the The Community Foot Care Service has improved the general foot condition of the institutional bound elderly by general foot condition of the institutional bound elderly by increased accessibility to podiatric care, one-stop multi-increased accessibility to podiatric care, one-stop multi-disciplinary referral, and shortened waiting time. disciplinary referral, and shortened waiting time.

Prevention and maintenance of chronic medical Prevention and maintenance of chronic medical conditions in the community are relatively low cost but conditions in the community are relatively low cost but can contribute significantly towards the reduction of can contribute significantly towards the reduction of overall health care expanses. overall health care expanses.

More emphasis and attention as well as resources More emphasis and attention as well as resources should be available at the community level to promote should be available at the community level to promote early prevention and care, in view of our aging society. early prevention and care, in view of our aging society.

Who would you want to Who would you want to SEESEE??

Who would you want to Who would you want to BEBE??