Health Economics
Pressure on the plantar surface of the foot is a factor in 90% of diabetic foot ulcers (DFUs), which is a frequent complication of diabetes.1 DFUs often develop a wound infection, requiring hospitalization and can precipitate foot/lower leg amputations. Wounds Canada’s 2021 Best Practice Guidelines for Prevention and Management of Diabetic Foot Ulcers highlights modifying or removing inappropriate pressure through pressure offloading is key in the treatment of DFUs.2
Methods:
In 2019 British Columbia did a Canadian Agency for Drugs and Technology in Health (CADTH) review and a Health Technology Assessment (HTA) on the use of DFU offloading devices. The studies highlighted strong evidence of their success but also highlighted the financial barriers in obtaining such devices
In June 2022 PharmaCare team members and Health Authority health care professionals worked together to develop a joint Health Authority/PharmaCare program to minimize these barriers.
Results:
The program’s first process was for patients with a DFU, successfully closed with total contact casting (TCC), to have access to PharmaCare coverage for offloading devices. The initiative took effect in January 2023. The process created four documents (see British Columbia PharmaCare website) including: PharmaCare Coverage TCC Offloading Devices Process, Orthotic Referral Form, Health Authority Outpatient/Ambulatory Clinic (TCC) List, PharmaCare Enrolled Orthotics Providers. An evaluation of the program is schedule for early 2024.
Discussion: DFUs have devastating complications therefore effective treatment of the wound followed by appropriate offloading devices is vital to all clients. To ensure all clients have access to this care, development of processes (provincial/ territorial, regional and local) that designate resources; human, material and financial, is needed to support the client and healthcare team in their diabetic foot management.