APMA News - March 2015 - (Page 22)

Building Effective Partnerships between Vascular Surgeons and Podiatrists in the Effective Management of Diabetic Foot Ulcers V Prepared by Timothy Wu, MD,a and Rabih A. Chaer, MD,a on behalf of the SVS Young Surgeons Committee and Nichol L. Salvo, DPM,b on behalf of the APMA Young Physicians' Leadership Panel ascular surgeons and podiatrists both care for patients with diabetic foot ulcerations (DFUs). These patients represent one of today's most challenging health-care populations in the US. The prevalence of DFUs has steadily increased along with the rising costs associated with care. Given the multiple comorbidities affecting these patients, a multidisciplinary approach is necessary in the management of their care. Such efforts, primarily led by podiatrists and vascular surgeons, have been shown to effectively decrease major limb loss. Establishing an interprofessional partnership between vascular surgery and podiatry can lead to an improvement in the delivery of care and outcomes of this vulnerable patient population.i This practice memo, a collaborative effort between the Young Physicians' Program of the American Podiatric Medical Association (APMA) and the Young Surgeons Committee of the Society for Vascular Surgery (SVS), is intended to aid podiatrists and vascular surgeons in the early years of their respective careers, especially those involved in the care of patients with DFUs. During these formative years, learning how to successfully establish an interprofessional partnership is crucial in order to provide the best possible care to this important patient population. Increasing Prevalence and Associated Costs In 2007, the Centers for Disease Control and Prevention reported an estimated 24 million people in the US were affected by diabetes, costing the health-care system $174 billion, of which $116 billion were direct patient care costs. Peripheral vascular complications accounted for 31 percent of these expenses and were among the major contributors to inpatient length of stay, which is a strong predictor of increased cost of care. An analysis of Medicare claims data from 1995 to 1996 showed that expenditures for diabetic foot patients were three times higher than for the general population ($15,309 versus $5,226). In one cost analysis, patients with DFUs healing without amputation averaged $6,664, whereas patients healing by amputation averaged an expense of nearly seven times more at $44,790.ii There is a significant economic reduction of associated cost when the podiatrist and vascular surgeon are utilized in the goal of limb salvage and amputation prevention. Carls et. al demonstrated that involving podiatric physicians in the multidisciplinary approach to the diabetic foot reduces the economic burden by $13,474 in patients covered by commercial plans and $3,624 in Medicare-covered patients.iii APMA and SVS Joint Statement In 2010, APMA and SVS released a joint statement outlining the importance of a collaborative, multidisciplinary team approach to care for patients with DFUs. The statement stressed that podiatrists and vascular surgeons are key components of the multidisciplinary team, but also noted the need for other medical and surgical specialists who can play equally important roles in the overall care of the many diabetes-related complications affecting this fragile group. Additionally, the statement cited data that have shown the effectiveness of a multidisciplinary team approach in terms of a University of Pittsburgh Medical Center, Pittsburgh, PA; b American Podiatric Medical Association, Bethesda, MD. i Sumpio BE, Armstrong DG, Lavery LA, et al. The role of interdisciplinary team approach in the management of the diabetic foot. J Vasc Surg 2010; 51:1504-1506. ii Driver VR, Fabbi M, Lavery LA, et al. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg 2010; 52:17S-22S. iii Carls GS, Gibson TB, Driver VR, Wrobel JS, Garoufalis MG, Defrancis RR, Wang S, Bagalman JE, Christina JR. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. J Am Podiatr Med Assoc. 2011 Mar-Apr; 101(2):93-115. Copyright 2015, Society for Vascular Surgery®; American Podiatric Medical Association, Inc. All rights reserved. SVS/APMA Practice Memo, Building Effective Partnerships Between Vascular Surgeons and Podiatrists in the Effective Management of Diabetic Foot Ulcers (January 2015) 22 APMA News March 2015

Table of Contents for the Digital Edition of APMA News - March 2015

Contents

APMA News - March 2015