Graft Treatment for Diabetic Foot Ulcers

David*, a 59-year-old construction worker with painful foot ulcers caused by advanced type 2 diabetes, didn’t like going to the doctor. Eventually his poor health forced him into early retirement and he reluctantly made an appointment with his clinician.

David left his doctor’s office with multiple prescriptions and an appointment to return for graft treatment for his foot ulcers. He was in pain, overwhelmed, and depressed. How could he keep track of his medications? Who would help him while he recovered from the grafts? How would he stay off his feet when he had to go grocery shopping?

Dr. Landers* was concerned that David wouldn’t offload or keep his grafts clean. She also knew that David didn’t like going to the doctor and worried that he wouldn’t keep up with his medications or come back for follow-up appointments. She suggested that David enroll in the Patient Support Program.

David’s Treatment Experience Nurse called to welcome him to the program and completed a barrier assessment, which was entered in the SmartCARE Platform and reported to David’s clinician through the Clinician Feedback Loop.

The Treatment Experience Nurse listened to David’s concerns and answered his questions. She gave him tips on how to care for his grafts, encouraged him to use his removable cast walker and to offload as much as possible. She helped him build a medication routine and suggested he make a list of family and friends who could take him to appointments.

During the next scheduled call with his Treatment Experience Nurse, David said he was feeling isolated and frustrated that he couldn’t be as active as he used to be while his grafts healed. The Treatment Experience Nurse empathized with David and suggested he talk about his feelings with his clinician, a friend/family member, or a support group. They also reviewed David’s list of family and friends and worked together to plan when David would call them and what he could ask them to do.

Once David opted to receive text messages, he got reminders about upcoming appointments, along with motivational tips such as:

• Ask for help if you need it, and be specific. Friends and family may be unsure about what they can do to help.
• Focus on what is in your control, like offloading, taking your medicine, and keeping up with monitoring appointments. It can help to know that you are taking positive steps for your health.
• Set small goals and focus on your progress to avoid frustration during treatment. Take it one day at a time, and celebrate your achievements.

During subsequent scheduled calls, the Treatment Experience Nurse continued to monitor David’s progress, reassess his barriers, and update his record for the SmartCARE Platform and Clinician Feedback Loop.

Dr. Landers told David that he should stay off his feet as much as possible and explained how to care for his grafts. She was concerned that David was overwhelmed by all the information and wouldn’t follow through without additional support.

Dr. Landers didn’t have the time or resources to address David’s psychosocial needs.

The Patient Support Program provided additional personalized support that complemented Dr. Lander’s care of her patients and helped her monitor their progress between appointments, including the:

• Treatment Experience Nurse, who educated David on how to care for his grafts, addressed his emotional needs, and offered support and advice throughout treatment
• Clinician Feedback Loop, which shared information collected by the Nurse Case Manager between appointments, including reported side effects, missed doses and refills, and barriers addressed

As a result of being enrolled in the Patient Support Program, patients like David were more likely to complete their full course of treatment and therefore have better outcomes. Clinicians were able to provide better care for their patients because the program helped clinicians set expectations for self-care, strengthened patient–clinician communication, and provided data between follow-up appointments.

*Illustrative, not an actual patient/clinician