Keeping Patients In Your Practice: A New Paradigm For Treating Infections

Andrew Rice, DPM, FACFAS

   It is vital to have a network of multidisciplinary specialists to whom one can refer patients. While appropriate referrals are key to ensuring optimal outcomes, the DPM should take the lead in facilitating the best treatment choices for patient care.

   As part of the Vision 2015 program, the American Podiatric Medical Association (APMA) has committed itself to achieving the mission of universal recognition of the work of podiatric medical physicians. Vision 2015 states, “(Podiatrists) should treat the patients within their specialty without restriction.”

   In order to meet this goal, we as podiatric physicians and surgeons must begin to take more direct care of our patients. Consider our experience in diagnosing and treating patients with lower extremity infections. Historically, DPMs have referred these patients away, often to medical doctors specializing in infectious diseases. Reasons for referrals include “spreading the liability” and hoping for “quid pro quo” referrals from the infectious disease doctor. I propose that using the infectious disease colleague as a consultant and managing the patient directly will benefit the patient and the profession of podiatric medicine as a whole.

   The direct benefit to the DPM is that the patient stays in your practice and is not referred away. We have all heard the term evidence-based medicine. This concept will bring to light the patient benefits of being treated by podiatric medical professionals by taking results of actual cases and documenting the results.

Emphasizing The Use Of Research To Document The Impact Of Podiatric Care

   The APMA’s Clinical Practice Advisory Committee (CPAC) looked at new emerging technologies that are relevant to podiatry and how those technologies can act as a conduit for research in the profession. In regard to research, the APMA’s mission statement also states it will “promote, manage and advise the (APMA) members on clinical and research opportunities that demonstrate the value of healthcare provided by doctors of podiatric medicine.”

   The five goals of the CPAC are:

   • transfer information to internal and appropriate external audiences;
   • strengthen and maintain the current evidence base for the development of standards, guidelines and policies for foot and ankle care;
   • encourage the growth of research infrastructure within the profession;
   • continue to investigate and quantify the health benefits and economic impact of care provided by doctors of podiatric medicine; and
   • promote the development and implementation of performance measures for foot and ankle care.

   In regard to accomplishing the second goal, key strategies in strengthening the evidence base would be the following:

   • identify the strengths and weaknesses of current evidence and methodology; and
   • prioritize areas of evidence-based medicine that need to be evaluated.

Facilitating Evidence-Based Research With Improved Data Collection

   In 2007, the specialty podiatric home infusion company QMedRx, in collaboration with the CPAC, created a data collection tool physicians can use when patients start on home intravenous antibiotic therapy. The pharmacy provider will aggregate the information and data that the profession collects and then return the info to the profession to facilitate evidence-based research and document superior patient outcomes.

   Patient outcome data gathering will enable us to aggregate nationwide information on infection care and other disease processes affecting the podiatric physicians and their patients. This tool will enable us to use evidence-based podiatric resources for additional support and decision making to guide lower extremity medicine and surgery nationwide. The national adoption and use of this tool will help us reach the goals of the APMA Vision 2015.

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