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Podiatric Physicians' Perspectives on Their Role in Promoting Self-Care in High-Risk Patients with Diabetes

Jennifer Tinloy Department of Medicine, Penn State College of Medicine, Hershey, PA.

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Shailja Kaul Penn State Hershey Diabetes Institute, Division of Endocrinology, Diabetes, and Metabolism, Penn State College of Medicine, Hershey, PA. Dr. Gabbay is now with Joslin Diabetes Center, Harvard Medical School, Boston, MA.

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Jan Ulbrecht Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA.

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Eric Schaefer Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.

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Robert A. Gabbay Penn State Hershey Diabetes Institute, Division of Endocrinology, Diabetes, and Metabolism, Penn State College of Medicine, Hershey, PA. Dr. Gabbay is now with Joslin Diabetes Center, Harvard Medical School, Boston, MA.

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Background

Foot self-care is key in preventing morbidity in high-risk diabetic patients. Motivational interviewing (MI) is an approach to encourage behavior change by patients that can be used in medical settings. The goal was to explore how podiatric physicians promote self-care in such patients and whether they use MI techniques.

Methods

We conducted a 19-question online survey of US-based practicing podiatric physicians. Most answers were on a 5-point scale. The MI index was the sum of answers to five relevant questions.

Results

Of 843 podiatric physicians, 86% considered foot self-care to be very important for high-risk diabetic patients, and 90% felt that it was their role to discuss foot self-care with them; 49% felt that they had training and were successful in promoting behavior change, but most were definitely (38%) or possibly (46%) interested in learning more. Only 24% of respondents scored at least 15 of 20 on the MI index. Higher MI scores were associated with more face time and more time discussing foot self-care but were not related to podiatric physicians' age, sex, geographic location, percentage of time in surgery, or years in practice. Reported barriers to counseling were lack of reimbursed time and poor patient engagement.

Conclusions

Most podiatric physicians view self-care behavior among high-risk diabetic patients and their role in promoting it as very important; most feel already proficient, but only a few demonstrate MI skills; most are willing to learn more. Success in behavioral counseling, such as MI, is likely to require more time and may be encouraged by a move from fee-for-service to outcome-based reimbursement.

Corresponding author: Robert A. Gabbay, MD, PhD, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. (E-mail: robert.gabbay@joslin.harvard.edu)