Background Foot and ankle involvement for people with rheumatoid arthritis (RA) is common and can significantly impact quality of life . As foot health care specialists, podiatrists have an important role in managing these problems . However, the provision for specialist podiatry care is often limited . The impact of current service provision on patients and the podiatrists treating these patients is unknown.
Objectives To explore the experiences of patients and podiatrists regarding podiatry care for people with RA and their opinions on what ideal foot health care would entail.
Methods Two focus groups were conducted with participants from five National Health Service (NHS) Health Boards in Scotland. The involved NHS Health Boards are responsible for the treatment of approximately 48% of the population with RA in Scotland. One focus group was conducted with patients who had previously received podiatry care, and a second focus group was conducted with podiatrists who treat patients with RA. Focus groups were recorded, transcribed and anonymised. Core concepts and associated themes were identified using the Framework approach. Core concepts and associated themes were discussed and agreed by all authors.
Results Five patients (all female) with mean ±SD age of 53.6±6.6 years and disease duration 15±11.1 years participated in the first focus group. The average duration of podiatry care was 7 years (range 3-15). Six rheumatology specialist podiatrists formed the second focus group. Both agreement and differences were observed between the two focus groups with regards to current podiatry services and ideal services, and the differences between them. Patients and podiatrists identified similar problems with the provision of podiatry care for people with RA and similar steps that could be taken to achieve ideal service provision. Two core concepts were identified – access to health care services and complex nature of podiatry care. In the former, themes of access facilitated (eg early referral) and access inhibited (eg limited access to specialist podiatrist) emerged from both focus groups. In the latter, themes of ideal service (eg national model) and complex intervention (eg individual treatments) emerged from both focus groups. Additionally, the theme of complex clinical structure (eg disease-stage focus) emerged from the focus group with the podiatrists. Overall, podiatry care was a positive experience for patients. However, gaps in specialist rheumatology podiatry services and improved education about the complex nature of foot involvement for patients and the multidisciplinary rheumatology team were identified as areas for improvement. These issues were also identified by the podiatrists. To combat these issues, both patients and podiatrists wanted a nationally adopted specialist rheumatology podiatry care model that allowed for early referral, greater flexibility and continuity of care, increased education for all involved, and a multidisciplinary team working closely together.
Conclusions Patients regard podiatry as a positive part of their overall care. However, improvements to services and moves towards a national model of care may be beneficial. These themes were also widely endorsed by the participating podiatrists.
Scott et al, 2005, Best Pract Res Cl Rheumatol, 19:117-136
Korda et al, 2004, Best Pract Res Cl Rheumatol, 18:587-611
Redmond et al, 2005, Rheumatology (Oxford), 45:571–576
Disclosure of Interest None Declared