(DCP028) CENTRE FOR COMPLEX DIABETES CARE VIRTUAL FOOTCARE PILOT PROGRAM

Background: COVID-19 identified new and existing barriers to patient care, none more apparent than to patients managing a diabetic foot ulcer. The necessity of frequent in-person appointments during a time when such visits were limited, prompted a novel and augmented approach to wound care delivery with the development of a Virtual Foot Care Program (VFCP). This pilot project focused on providing wound patients at the Centre for Complex Diabetes Care (CCDC) with improved access to their clinicians, timely wound assessments and minimal interruptions to regular care.

METHODS AND RESULTS: All participants meeting inclusion criteria (Table A) signed their consent to participate and received a “tool-kit” (Table B). Patients received live training on “tool-kit” items and tablet device. Participants were expected to follow-up virtually, according to their current scheduling, with periodic in-person visits at the CCDC to maintain best practice. Participants were followed to wound closure, dropout or an inability to continue. Upon completion, participants, their supports and clinicians were asked to provide open-ended feedback.
There were nine participants in the VFCP. Six followed through with at least one virtual appointment. Two demonstrated difficulties using the equipment and declined further follow-up. One participant was lost to follow-up due to hospitalization.
Overall feedback was generally favourable. Most participants and their supports found virtual access to be very convenient, saving time and money on already demanding schedules. One patient noted a positive effect on his mental health, alleviating stress related to COVID-19. Clinicians found the increased access extremely valuable, as up-to-date assessments meant management plans could be confirmed and adjusted without delay. Furthermore, the opportunity to collaborate with other clinicians helped to identify previously unknown gaps in care.
Some participants found virtual appointments “intimidating”, while one voiced his preference to be seen in-person, citing prior negative experiences with virtual care. Clinicians reported the time required to train and get patients comfortable using a device during appointments as their primary obstacles.

Conclusion: Though regular in-person patient care has resumed to levels prior to COVID-19, the VFCP demonstrates how conventional care services models can be enhanced to support wound care delivery through increased access to care while addressing common barriers wound patients face. This program demonstrates how we can embrace technology in wound care, and it’s an area that must evolve with the proper resources and shift in vision to what is possible beyond the traditional hands-on service model.