Developing the workforce:
A Public Health Role for Podiatrists
Mathew King Prevention and Education Pathway Lead Podiatrist
Aims: 1.
Identify the role of podiatrists in DH policy context
2.
Describe the Solent NHS Trust Podiatry Prevention Pathway
3.
Demonstrate how the service is working
4.
Open discussion on how this can be taken forward
Key Policy Documentation – Promoting Prevention
Key Documentation Summary: Flexible and responsive workforce, able to respond to the changing needs of society A High Quality Workforce highlights the need for the NHS and its national and local partners to work together more effectively, making a stronger contribution to promoting health and ensuring easier access to prevention services.
Why Podiatrists? An estimated 61,000 people with diabetes in England have foot ulcers
at any given time
There are around 6,000 lower extremity amputations a year in people
with diabetes
80% diabetic foot ulceration is preventable PVD and Neuropathy are the biggest risk factors to ulceration
Role of the Podiatrist is to maintain independence and mobility.
It‘s only evolution…
H. australopithecus
Dr Kash Rizvi KGH
H. erectus
H. sapiens
H. McBurger
Training The Podiatry Team each have achieved Level 2 Qualification
from the Royal Society of Public Health in Understanding Health Improvement.
The team received training as brief intervention advisors in
Public Health
Behaviour Change in LTC
Not just changing patient/public behaviour we also need to
change practitioner behaviour.
It is easy for the team to be absorbed and influenced by
traditional practice and behaviour.
Offering Public Health advice on key priorities;
Smoking Cessation Flu Vaccination Alcohol Abuse Exercise and Nutrition Winter Warmth Falls Prevention
Provide opportunistic advice during consultations. Relating the behaviour to the medical condition.
Achievements Brief Intervention Intention to change behaviour
Smoking Cessation
Weight Management
Alcohol Misuse
Flu Vaccination
Winter Warmth
Falls Prevention
64.00%
48.00%
24.00%
20.00%
20.00%
12.00%
Table 1 below shows the percentage of patients that recorded an intention to change their behaviour for the better. Health review assessment 1 asked the patients if, following brief intervention, they intended to change their behaviour. The figures were recorded as a yes or no answer and displayed as a percentage.
Brief Intervention
Smoking Cessation
Weight Management
Alcohol Misuse
Flu Vaccination
Winter Warmth
Falls Prevention
Sustained Change
36.00%
16.00%
20.00%
20.00%
16.00%
12.00%
Maintain Change
36.00%
16.00%
16.00%
20.00%
16.00%
12.00%
Health review assessment 1 Table 2 shows the results of health review assessment 2 which was sent to the patient 6 weeks after brief intervention to demonstrate sustained change and the measures taken to maintain that change. Once again the figures are displayed as a percentage. The brief intervention changed some participant’s behaviours for the better in every public health initiative. 46 of the 150 participants felt they would change their behaviour immediately after the brief intervention. 30 of the 46 participants registered a change in behaviour 6 weeks after the brief intervention. The results for the behaviour change are impressive considering the brief intervention was given opportunistically. The patients all attended with foot complaints and were not expecting to receive public health advice.
Average
Importance difference
Confidence difference
Attitude
Motivation
Success
1.54
1.79
89.81%
87.50%
Failure
0.46
0.73
29.46%
31.63%
Overall
0.64
0.95
40.67%
42.67%
The above table illustrates an average percentage of all 6 public health interventions together.
The success row shows the values for all the participants that made a positive behaviour change in their respective public health topic. The failure row is the values of participants that did not change their behaviour. The values are an average increase/decrease in ‘Rollnick’s ruler’ score for importance and confidence. The participants that recorded a ‘yes’ response to a positive change in attitude and motivation contribute to the average percentage. Also an overall row is included showing values of both success and failure regardless of whether the participant changed their behaviour.
Achievements
Invited to be on the DoH National AHP Clinical Expert Database for Public Health
Summary As patients are more likely to act on advice from practitioners they know and trust, podiatrists are well positioned to play a more preventative role to reduce the incidence of acute stage foot disease. This is not limited to Podiatry. All AHP’s can and should make every
contact count.
Should be part of all AHP undergraduate learning.
Any Questions?
[email protected]
