The Lower-Limb Preservation (LLP) demonstration program of the Downtown East Toronto Ontario Health Team (DET OHT) is gearing up for launch in October 2023. The project consists of two working groups, namely 'Screening and Prevention' and 'Escalation of Care', which are leading these efforts. Both groups are focused on addressing the critical foot care needs of individuals receiving care in the Downtown East area.
The goal of the Screening and Prevention Working Group is to enhance the regularity and consistency of foot screening. It has been observed that individuals with diabetes and/or peripheral artery disease, who are at a higher risk of developing foot complications, often do not remove their socks for screening during their consultation visits. Therefore, this working group is developing a foot screening tool to help identify risk of complications and care needs for appropriate and timely referrals.
The Escalation of Care Working Group has two primary goals. First, they aim to define clear referral categories. Second, they intend to improve the process for guiding patients with open wounds and at a high risk of non-traumatic, major lower-limb amputation to acute care settings and hospital-based clinics.
“Screening and prevention and escalation of care are the pillars of the DET OHT LLP strategy,” says Yallenni Ilamvaluthy, LLP Project Manager. “Our goals are to have as many feet screened as possible and ensure that the right referral is made at the right time to the right place.”
Prior to planning for the implementation, the project team engaged with diverse groups of care providers and conducted surveys. These activities aimed to identify current trends, care gaps, and patient navigation pathways for lower-limb care in Downtown East Toronto. The findings from the surveys highlighted substantial challenges faced by the Downtown East population, including:
- lack of preventive foot care and timely patient referrals to appropriate care settings,
- financial barriers for patients without health coverage, such as OHIP and/or extended health benefits,
- and inconsistent foot screening services within the community and hospital settings, which could increase the threat of non-traumatic lower-limb amputations.
“The survey findings confirmed the importance of addressing inconsistencies with foot screening and barriers to accessing foot care services,” says Sandra Fitzpatrick, Lead of the Screening and Prevention working group. “It is our hope that developing a screening tool, leveraging digital enablers, enhancing access to foot care services, and clearly mapping care pathways will support healthcare providers and patients in reducing the risk of non-traumatic, major lower limb amputations.
Both Working Groups are closely collaborating with multidisciplinary teams. These include clinical leads, project managers, diabetes educators, and chiropodists from primary care, community health, and acute care settings. They are also co-designing the implementation strategy with the community partners who have firsthand experience in accessing foot care.
The phased implementation of the project will kick off with the launch in October 2023. This initial phase will focus on primary care providers working to improve various points of entry for patients/clients along care pathways.
Keep an eye out for further updates as we assess the project's progress.