Skip to main content
Log in

Intersektorale Versorgung von Patienten mit diabetischem Fußsyndrom

Intersectoral care of patients with diabetic foot syndrome

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Aufgrund seiner klinischen Komplexität und häufig unzureichender intersektoraler Kommunikation bei der Organisation seines Managements sind ungünstige Behandlungsverläufe beim diabetischen Fußsyndrom in Deutschland noch immer häufig. Disease-Management-Programme (DMP), Modelle zur integrierten Versorgung (IV) und „Case-management“(CM)-Projekte stellen Versuche dar, diese Situation zu verbessern. Die Besonderheiten der einzelnen Ansätze, ihr mögliches Zusammenwirken, aber auch Probleme bei ihrer Umsetzung werden in der vorliegenden Publikation umfassend vorgestellt und diskutiert.

Abstract

Due to the clinical complexity and often insufficient intersectoral communication in the organizational management, unfavorable treatment courses of diabetic foot syndrome are still common in Germany. Disease management programs (DMP), models for integrated care and case management projects represent attempts to improve this situation. The special features of the individual approaches, the possible interactions and also problems in implementation are comprehensively presented and discussed in this article.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Sumpio BE, Armstrong DG, Lavery LA, Andros G (2010) The role of interdisciplinary team approach in the management of the diabetic foot. A joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. J Vasc Surg 51:1504–1506

    Article  PubMed  Google Scholar 

  2. International Working Group on the Diabetic Foot (2007) International consensus on the diabetic foot & practical guidelines on the diabetic foot. http://www.idf.org/bookshop

  3. Bauer H et al (2009) Nationale VersorgungsLeitlinie Typ II-Diabetes – Präventions- und Behandlungsstrategien für Fußkomplikationen. Kirchheim, Mainz. http://www.diabetes.versorgungsleitlinie.de

  4. Prompers L, Huijberts M, Apelqvist J et al (2007) High prevalence of ischemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia 50:18–25

    Article  CAS  PubMed  Google Scholar 

  5. Santosa F, Moysidis T, Kanya S et al (2013) Decrease in major amputations in Germany. Int Wound J. DOI 10.1111/iwj.12096

  6. Heller G, Günster C, Swart E (2005) Über die Häufigkeit von Amputationen unterer Extremitäten in Deutschland. Dtsch Med Wochenschr 130:1689–1690

    Article  CAS  PubMed  Google Scholar 

  7. Norgren L, Hiatt WR, Dormandy JA et al (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 33:S1–S75

    Article  PubMed  Google Scholar 

  8. Albers M, Romiti M, Brochado-Neto FC et al (2006) Meta-analysis of popliteal-to-distal vein bypass grafts for critical ischemia. J Vasc Surg 43:498–503

    Article  PubMed  Google Scholar 

  9. Simms M (2009) Surgical treatment of the diabetic foot. J Cardiovasc Surg 50:293–311

    CAS  Google Scholar 

  10. Holstein P, Ellitsgaard N, Olsen BB, Ellitsgaard V (2000) Decreasing incidence of major amputations in people with diabetes. Diabetologia 43:844–847

    Article  CAS  PubMed  Google Scholar 

  11. Goshima KR, Mills JL Sr, Hughes JD (2004) A new look at outcomes after infrainguinal bypass surgery: traditional reporting standards systematically underestimate the expenditure of effort required to attain limb salvage. J Vasc Surg 39:330–335

    Article  PubMed  Google Scholar 

  12. Joyce PR, Khan A, Jones AV (1981) The revolving door patient. Compr Psychiatry 22:397–403

    Article  CAS  PubMed  Google Scholar 

  13. Rümenapf G, Geiger S, Schneider B et al (2013) Readmissions of patients with diabetes and foot ulcers after infra-popliteal bypass surgery: attacking the problem by an integrated case management model. Vasa 42:56–67

    Article  PubMed  Google Scholar 

  14. Morbach S, Müller E, Reike H et al (2009) Evidenzbasierte Leitlinien. Diagnostik, Therapie, Verlaufskontrolle und Prävention des diabetischen Fußsyndroms. Diabetologie 4:301–325

    Article  Google Scholar 

  15. Setacci C, Ricco JB et al (2011) Guidelines for critical limb ischaemia and diabetic foot - introduction. Eur J Vasc Endovasc Surg 42(Suppl 2):S1–S3

    Article  PubMed  Google Scholar 

  16. Kongstvedt PR (2000) The managed health care handbook. Jones and Bartlett, Burlington. ISBN 0-8342-1726-0

  17. Linder R, Ahrens S, Köppel D et al (2011) The benefit and efficiency of the disease management program for type 2 diabetes. Dtsch Arztebl Int 108(10):155–162. DOI 10.3238/arztebl.2011.0155

    PubMed Central  PubMed  Google Scholar 

  18. Hochlenert D, Engels G, Altenhofen L (2006) Integrierte Versorgung: Ergebnisse des Netzwerkes Diabetischer Fuß Köln und Umgebung. Dtsch Ärztebl 103(24):A1680–A1683

    Google Scholar 

  19. Stein V, Rieder A (2009) Lost in transition – meeting the challenge through integrated care. Highlights from the 9th International Conference on Integrated Care in Vienna. Int J Integr Care 9:1–11

    Google Scholar 

  20. Case Management Society of America. „Definition of Case Management“. http://www.cmsa.org/Default.aspx?tabid=104. Zugegriffen: 30.Okt. 2014

  21. Lavery LA, Wunderlich RP, Tredwell JL (2005) Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations. Diabetes Res Clin Pract 70(1):31–37

    Article  PubMed  Google Scholar 

  22. Horswell RL, Birke JA, Patout CA Jr (2003) A staged management diabetes foot program versus standard care: a 1-year cost and utilization comparison in a state public hospital system. Arch Phys Med Rehabil 84(12):1743–1746

    Article  PubMed  Google Scholar 

  23. Trautner C, Haastert B, Mauckner P et al (2007) Reduced incidence of lower-limb amputations in the diabetic population of a German city, 1990–2005: results of the Leverkusen Amputation Reduction Study (LARS). Diabetes Care 30(10):2633–2637

    Article  PubMed  Google Scholar 

  24. Ullrich W, Marschall U, Graf C (2007) Versorgungsmerkmale des Diabetes mellitus in Disease-Management-Programmen. Diabetes Stoffwechs Herz 6:407–414

    Google Scholar 

  25. Ose D, Freund T, Urban E et al (2012) Comorbidity and patient-reported quality of care: an evaluation of the primary care based German disease management program for type 2 diabetes. J Public Health 20:41–46

    Article  Google Scholar 

  26. Miksch A, Laux G, Ose D et al (2010) Is there a survival benefit within a German primary care-based disease management program? Am J Manag Care 16(1):49–54

    PubMed  Google Scholar 

  27. Risse A, Hochlenert D (2010) Integrierte Versorgung. Neue (?) Versorgungsform am Beispiel des diabetischen Fußsyndroms. Diabetologe. DOI 10.1007/s11428-009-0480-3

  28. Rathmann W, Haastert B, Icks A et al (2003) High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000. Diabetologia 46:182–189

    CAS  PubMed  Google Scholar 

  29. Rümenapf G, Morbach S, Müller E et al (2009) Der diabetische Fuß – eine interdisziplinäre Aufgabe. Gefäßchirurgie 14:167–168

    Article  Google Scholar 

  30. Dolderer M, Güldensupp H, Amelung VE (2007) Das Projekt zur integrierten Versorgung Endoprothetik Münster. In: Weatherly JN et al (Hrsg) Leuchtturmprojekte integrierter Versorgung und Medizinischer Versorgungszentren. MWV Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin, S 72–82

  31. McCullough DK, Prince MJ, Hindmarsh M, Wagner EH (1998) A population-based approach to diabetes management in a primary care setting: early results and lessons learned. Eff Clin Pract 1:12–22

    Google Scholar 

  32. Chang HC, Chang YC, Lee SM et al (2007) The effectiveness of hospital-based diabetes case management: an example from a northern Taiwan regional hospital. J Nurs Res 15:296–308

    Article  PubMed  Google Scholar 

  33. Donohue ME, Fletton JA, Hook A et al (2000) Improving foot care for people with diabetes mellitus – a randomized controlled trial of an integrated care approach. Diabet Med 17:581–587

    Article  Google Scholar 

  34. Doxford MJ, Rashid H, Edmonds ME (o J) The diabetic foot practioneer – a new approach to diabetic foot in-patient care, resulting in a reduction of hospital length of stay. 4th International Meeting on the Diabetic Foot, Noordwijkerhout, The Netherlands, 2003, O 22. dmp_elsid_abschlussbericht_2012.pdfLiteratur

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Rümenapf, S. Morbach, J. Boettrich, S. Geiger und N. Nagel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G. Rümenapf.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rümenapf, G., Morbach, S., Boettrich, J. et al. Intersektorale Versorgung von Patienten mit diabetischem Fußsyndrom. Diabetologe 11, 22–27 (2015). https://doi.org/10.1007/s11428-014-1321-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11428-014-1321-6

Schlüsselwörter

Keywords

Navigation