Mathew King

Prevention and Education Pathway Lead Podiatrist

Developing the workforce:A Public Health Role

for Podiatrists

Aims:1. Identify the role of podiatrists in DH policy

context

2. Describe the Solent NHS Trust Podiatry Prevention Pathway

3. Demonstrate how the service is working

4. Open discussion on how this can be taken forward

Key Policy Documentation –Promoting Prevention

Key Documentation Summary:

Flexible and responsive workforce, able to respond to the changing needs of society

A High Quality Workforce highlights the need for the NHS and its national and local partners to work together more effectively, making a stronger contribution to promoting health and ensuring easier access to prevention services.

Why Podiatrists?An estimated 61,000 people with diabetes in England have

foot ulcers at any given time

There are around 6,000 lower extremity amputations a year in people with diabetes

80% diabetic foot ulceration is preventable

PVD and Neuropathy are the biggest risk factors to ulceration

Role of the Podiatrist is to maintain independence and mobility.

It‘s only evolution…

Dr Kash Rizvi KGH

H. erectus H. sapiens H. McBurgerH. australopithecus

TrainingThe Podiatry Team each have achieved Level 2

Qualification from the Royal Society of Public Health in Understanding Health Improvement.

The team received training as brief intervention advisors in Public Health

Behaviour Change in LTC

Not just changing patient/public behaviour we also need to change practitioner behaviour.

It is easy for the team to be absorbed and influenced by traditional practice and behaviour.

Offering Public Health advice on key priorities;-

Smoking CessationFlu VaccinationAlcohol AbuseExercise and NutritionWinter Warmth Falls Prevention

Provide opportunistic advice during consultations.

Relating the behaviour to the medical condition.

AchievementsBrief Intervention Smoking

CessationWeight

ManagementAlcohol Misuse

Flu Vaccination

Winter Warmth

Falls Prevention

Intention to change behaviour 64.00% 48.00% 24.00% 20.00% 20.00% 12.00%

Brief Intervention Smoking Cessation

Weight Management

Alcohol Misuse

Flu Vaccination

Winter Warmth

Falls Prevention

Sustained Change 36.00% 16.00% 20.00% 20.00% 16.00% 12.00%

Maintain Change 36.00% 16.00% 16.00% 20.00% 16.00% 12.00%

Health review assessment 1Table 2 shows the results of health review assessment 2 which was sent to the patient 6 weeks after brief intervention to demonstrate sustained change and the measures taken to maintain that change. Once again the figures are displayed as a percentage.The brief intervention changed some participant’s behaviours for the better in every public health initiative. 46 of the 150 participants felt they would change their behaviour immediately after the brief intervention. 30 of the 46 participants registered a change in behaviour 6 weeks after the brief intervention. The results for the behaviour change are impressive considering the brief intervention was given opportunistically. The patients all attended with foot complaints and were not expecting to receive public health advice.

Table 1 below shows the percentage of patients that recorded an intention to change their behaviour for the better. Health review assessment 1 asked the patients if, following brief intervention, they intended to change their behaviour. The figures were recorded as a yes or no answer and displayed as a percentage.

Importance difference

Confidence difference Attitude Motivation

AverageSuccess 1.54 1.79 89.81% 87.50%

Failure 0.46 0.73 29.46% 31.63%

Overall 0.64 0.95 40.67% 42.67%

The above table illustrates an average percentage of all 6 public health interventions together.

The success row shows the values for all the participants that made a positive behaviour change in their respective public health topic. The failure row is the values of participants that did not change their behaviour.

The values are an average increase/decrease in ‘Rollnick’s ruler’ score for importance and confidence. The participants that recorded a ‘yes’ response to a positive change in attitude and motivation contribute to the average percentage.

Also an overall row is included showing values of both success and failure regardless of whether the participant changed their behaviour.

Achievements

Invited to be on the DoH National AHP Clinical Expert Database for Public Health

As patients are more likely to act on advice from practitioners they know and trust,

podiatrists are well positioned to play a more preventative role to reduce the incidence of

acute stage foot disease.

This is not limited to Podiatry. All AHP’s can and should make every contact count.

Should be part of all AHP undergraduate learning.

Summary

Any Questions?

Mathew.King@Solent.nhs.uk