Therapeutic Itinerary and Causes of Delay in Specialized Consultation of Patients Admitted for Diabetic Foot

Abstract

Introduction : Amputation remains a common practice in patients admitted for diabetic foot. The delay in consultation is one of the main reasons. The objective of this work was to analyze patients’ itinerary care and to identify the causes of delay in consultation in patients admitted for diabetic foot. Method : This is a descriptive cross-sectional study, including all patients hospitalized for diabetic foot. A wait of at least seven (7) days before consulting the Endocrinology department of Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) after the foot injury occurred was considered as delay in consultation. The data were recorded and analyzed in the EPI INFO software. The description of the sample was made according to the usual statistics (frequency, average, standard deviation). Results : Seventy-six (76) diabetic foot cases were admitted during the period of the study. The mean age of the patients was 56.64 ± 10.71 years with extremes of 29 years and 84 years. Patients were most often received at an advanced stage of the foot injury, 3D stage of Texas classification in 87% of cases and Wagner grades 4 and 5 in 52% of cases. The amputation rate was 38.16%. An analysis of the first care places reveals that 90.8% of patients had consulted conventional medicine, 13.2% in traditional medicine; 1.2% had religious practices and 18.7% had declared self-medication at home. Consultation period at CNHU HKM was more than 7 days in 80% of cases and less than 7 days in 20% of cases. The average consultation time was 44.08 ± 26.43 days with extremes of 1 and 480 days. The main reasons for the delay in seeking hospital care cited by diabetic patients were fear of amputation (47.8% of cases), economic difficulties (32.5% of cases) and awareness lack of the situation seriousness (22.4%). Conclusion : The therapeutic itinerary of patients with diabetic foot was particularly long. The main reasons of late appeal to specialized care were fear of amputation and economic difficulties. The implementation of universal health insurance and an information, education and communication program could certainly reduce the periods allowed for recourse to care and therefore to reduce the amputation rate.