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Saturday, March 30, 2019

Diabetes and Feet: Why do people not go to the podiatrist?




Australia has a very high number of lower limb amputations, and many experts believe most are preventable with greater awareness of the dangers of diabetes in the earlier stages of the disease and better access to services. Foot problems are a leading cause of hospitalisation in Australia which makes it essential for those in high risk to be able to access subsidised, regular consultations and services. The total annual cost for Australians with type 2 diabetes is up to $6 billion including healthcare costs, the cost of carers and Commonwealth government subsidies. The average annual healthcare cost per person with diabetes is $4,025 if there are no associated complications. However, this can rise to as much as $9,645 in people with both micro- and macrovascular complications. For type 1 diabetes, the total annual cost in Australia is $570 million, with the total average annual cost per person being $4,669. The average total annual cost is $3,468 for people without complications; however, this can rise to $16,698 for people with both micro- and macro vascular complications. One visit to a podiatrist can reduce the risk of serious complication by as much as a third. So it makes sense to make a friend of your podiatrist especially if you are trying to cope with a chronic disease like Diabetes.

So why do people not use podiatry services more?

The majority of podiatrists in Australia work in the private sector and a single consultation can cost $90 (or more) which if you do not have private health insurance is an expensive exercise. On average it is not uncommon to attend for podiatrist maintenance every 6- 8 weeks, and more if skin and nail pathologies persist. So that does knock a hole in your pocket.



Currently, GPs may refer people coping with chronic illness such as diabetes to specialist services such as podiatrist, physiotherapist and other health care profession through Medicare. The Chronic Disease Management program allows up to five consultations per calendar year. However when a person requires help from several health professionals, then you need to share the five visits among them. The immediate benefit to the GP is they receive a professional evaluation which helps them manage their patients in a more informed way. Many people, however, use their free Medicare referral to cover the most expensive fees, which is perfectly understandable but does mean they ignore important preventative services such as podiatry.



Australian podiatrists have been lobbying parliamentarians to increase the number of Medicare Subsidised podiatry visits to 12 per year. This would allow greater access to more health professions and allow for appropriate foot monitoring on an ongoing basis.



Australian podiatrists with suitable training can now prescribe restricted medicines such as antibiotics as well as refer to diagnostic services. However as the regulations currently stand, prescriptions from the podiatrist are not subsidized by the Pharmaceutical Benefits Scheme (PBS); and whilst referrals to diagnostic testing and medical imaging including ultrasound are covered for the foot and ankle under Medicare, CT and MRIs are not currently covered by Medicare Benefits Schedule (MBS). Consequently, patients are charged in full. This hampers client care and frustrates professionals all at a time when diabetes is a pandemic.

Footnote
Special thanks to Doctor Andrew Schox at Perth Foot & Ankle Clinic , and Dr Paul Tinley for their assistance in preparing this post.

Bibliography
Australian Podiatry Association Collins R 2017 The Rising Economic Cost of Diabetes Canstar
Diabetes: The silent pandemic and its impact on Australia
Foot care - Diabetes Australia
Schofield1 D, Shrestha RN, Cunich CM, Passey ME, Veerman L, Tanton R, and Kelly SJ 2017 The costs of diabetes among Australians aged 45–64 years from 2015 to 2030: projections of lost productive life years (PLYs), lost personal income, lost taxation revenue, extra welfare payments and lost gross domestic product from Health&WealthMOD2030 BMJ Open ; 7:e013158. doi: 10.1136/bmjopen-2016-013158

Reviewed 30/03/2019

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