Patient Adherence And Prevention Of Nontraumatic Amputations

11-28-2006 | Categories:

Clinical Info

To Prevent Amputations, Doctors Call for Aggressive Care By Elizabeth Svoboda. New York Times November 7, 2006

The central point of this article is the possibility of preventing amputation as a consequence of disease, especially diabetes. This is not an uncommon outcome; 1.8 million Americans have had amputations, and more than 100,000 non-accident-related, lower-limb amputations are performed annually in the United States.

Dr. Karel Bakker, a foot specialist who is a chairman of the International Diabetes Federation, believes that more effective foot care and patient education strategies would render up to 85 percent of these procedures unnecessary. Lower-limb ulcers are the most reliable harbingers of future amputation: according to a study published earlier this year in the journal Diabetes Care, nearly 9 in 10 nontraumatic foot and leg amputations come after the development of these infected sores, which can spread and quickly destroy surrounding tissue. … With proper education, observation and follow-up care, Dr. Bakker argues, most patients at high risk of amputation could be healed before reaching the point of no return. He envisions an across-the-board protocol of aggressive wound care that would function a little like early-stage cancer treatment, vanquishing relatively minor sores and irritations before they have a chance to become something more serious.

The issue of patient compliance, however, is paramount.

Dr. Pinzur, however, thinks it is unrealistic to expect the levels of patient compliance needed to achieve the results that Dr. Bakker and Dr. Beaglehole envision. Many diabetics, he notes, have difficulty learning to administer proper wound care, and many other patients do not follow doctors’ orders or show up for scheduled visits. “ “One-on-one patient education is really the only solution,” he said.

Commentary

In addition to the importance of amputations themselves, this article is significant because (1) it is a reminder that, while medication compliance receives the lion’s share of attention in the field of patient compliance, nonadherence is a frequent and devastating problem in almost every kind of treatment regimen and (2) clinicians have a responsibility to make treatment recommendations that are based on realistic expectations of compliance in general and a realistic assessment of the specific patient’s capacity for compliance.

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