The number of people with diabetes will increase considerably both globally and in Norway in the future. The extent of sequelae related to diabetes is also therefore likely to increase. Studies emphasize that diabetes-related foot ulcers represent challenges for individual people and for health care services. Health care services therefore need to be organized in the coming years such that follow-up routines enable close clinical follow-up care for people with diabetes both in primary care (community care organized at the municipal level) and in hospital (specialist care organized by the state). The National Health Plan for Norway (2007–2010) emphasized that information and communication technologies are an important way of reaching health policy aims in the course of more integrated treatment and care pathways across organizational boundaries. However, randomized controlled studies have not adequately documented that telemedicine follow-up care for people diabetes-related foot ulcers results in equivalent healing time versus traditional follow-up care in specialist health care.
This study will investigate whether telemedicine follow-up care for people with diabetes-related foot ulcers in municipal primary health care in collaboration with specialist health care is an equivalent alternative to traditional outpatient clinical follow-up in specialist health care (noninferiority trial) in relation to healing time. We will change the treatment routines for diabetes-related foot ulcers for the intervention group as an alternative to traditional follow-up in specialist health care. A nurse in municipal primary health care will use telemedicine equipment to transfer images of the foot ulcer captured by mobile telephone for assessment. The nurse can then perform wound care in accordance with the assessment of specialist health care. We have designed the main study as a cluster randomized controlled trial. The primary endpoint in the study is healing time, measured from the time the person is included in the study until the foot ulcer is healed or the study ends (after 12 months).
The project is in accordance with national guidelines and will contribute to increasing the focus on research related to integrated care.If follow-up care for diabetic foot ulcers in municipal primary health care produces healing time similar to that of specialist health care and provides positive health gains for the individual people with diabetes by increasing their satisfaction, reducing diabetes-related stress, reducing anxiety and depression symptoms and reducing sickness absence, this new model will be an alternative to the current organization of specialist health care and thus realize of the goal of coordinating and integrating health care.