Registed Nurses' Association of Ontario

RNAO and CAWC Joint Letter on Diabetic Foot Care in Ontario

RNAO and CAWC Joint Letter on Diabetic Foot Care in Ontario

Dear Minister Hoskins,

We are writing to request an urgent meeting with you to discuss how we can partner to ensure progress in Ontario's Diabetes Strategy.

We acknowledge the government investments in the Ontario Diabetes Strategy which has resulted in improved screening, prevention and treatment of some diabetes related complications in the province. However, the prevalence of one of the most devastating outcomes of diabetes -- foot ulcers and amputations -- continues to grow. Ministry of Health and Long-Term Care data shows that in fiscal year 2008/9 there were 18,341 hospitalizations in Ontario due to diabetic foot ulcers or amputations. In 2010/11 there were 33,199. This has direct and devastating implications for the approximately 1.46 million Ontarians with diabetes, their families, the services that support them, and the health system as a whole.

Chief among these gaps is the fact that most Ontarians with diabetic foot complications have to pay out of pocket for the care they need, which includes preventative shoes, socks, offloading devices and chiropody/podiatry/nursing treatment. Also of critical import is that primary care screening rates for diabetic foot complications in Canada are currently the lowest among high income countries. Furthermore people with early signs of diabetic foot complications often have no place to go, beyond the emergency room. Unlike jurisdictions such as the United Kingdom, Ontario lacks regional multidisciplinary diabetes foot care teams to perform emergency limb salvage. These gaps lead to a failure of diabetic foot ulcers to heal in a timely fashion. This, in turn, exposes Ontarians with diabetes to gangrene, bone infections (osteomyelitis), numerous visits, longer healing times and, unfortunately, lower limb amputations that are preventable.

Minister, we were excited to see Ontario display a leadership role by highlighting diabetic foot care as a national priority at the 2012 First Minister’s Conference in Halifax and to see RNAO’s Best Practice Guideline Assessment and Management of Foot Ulcers for People with Diabetes, 2nd ed. selected for national implementation by the Council of the Federation Clinical Practice Guidelines Working Group, in 2013. This is also why we support Ontario’s ‘Life or Limb Policy’, which aims to facilitate timely access to acute care services within a best effort window of 4 hours for patients who are life or limb threatened.

We want to propose to you a more coordinated and integrated system of care, one that would serve to improve patient outcomes, while providing the health system with substantial cost savings – as the system cost of a single diabetic foot ulcer requiring amputation is $70,000. We believe there are a number of key opportunities for your Ministry to drastically improve the diabetic foot care situation in our great province. To that end, we the undersigned, recommend your Ministry take leadership in the following areas:

  1. Providing universal access to preventative foot care services, including supplying preventative shoes, socks and offloading devices to those in need, free at the point of care, for all Ontarians living with diabetes;
  2. Developing policies that enable every Ontarian with diabetes to have at least one foot assessment by a qualified health provider per year;
  3. Adopting an Ontario-wide interprofessional approach to diabetic foot care, with at least one multidisciplinary diabetes foot care team, with a well-defined referral pattern, in each Local Health Integration Network (LHIN);
  4. Publish, on an annual basis, reliable data on diabetes foot care, using internationally recognized metrics, to assist on-going quality improvement efforts.

We believe universal access to preventative diabetic foot care will decrease ulcers and amputations, in the same way that retinopathy screening and treatment has decreased diabetes related blindness -- and, it will also decrease overall provincial spending.

Thank you for your attention to these issues. We will follow-up with your office to schedule a meeting so that together we improve foot screening and care. In doing so we can save the limbs and lives of Ontarians living with diabetes.

With warmest regards,

Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT.
Chief Executive Officer
Registered Nurses’ Association of Ontario

Mariam Botros, CDE, D.Ch, IIWCC
Executive Director
Canadian Association of Wound Care
Director, Diabetic Foot Canada
Co-editor, Diabetic Foot Canada Journal

cc. Hon. Kathleen Wynne, Premier of Ontario
Dr. Bob Bell, Deputy Minister of Health and Long-Term Care

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RNAO and CAWC Joint Letter on Diabetic Foot Care in Ontario310.32 Ko
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Letter