Provider Knowledge And Practices Regarding Onychomycosis Treatment In Diabetic Patients, Before And After Online Module

Abstract

Background: Diabetes is a devastating chronic health condition affecting roughly 6% of the population would-wide (World Health Organization, 2019). The numerous complications from diabetes can initially be insidious, over time becoming debilitating and often deadly. Chronic lower extremity ulceration and subsequent complications, including limb amputation, is a common consequence of long-term hyperglycemia as in poorly managed diabetes. Annual diabetic foot exams, assessing for signs of risk and ulceration, are recommended as a method of prevention of this complication (Persaud et al., 2018). Evidence shows an association between mycotic toenail infection, onychomycosis, and increased risk of foot ulceration, amputation and subsequent 5-year mortality in diabetic patients (Morbach et al., 2012). Screening for and aggressive treatment of onychomycosis in diabetic patients is recommended, although this is a commonly overlooked and undermanaged comorbidity (Ibrahim et al., 2017). Purpose: The purpose of this quality improvement project is to increase provider awareness of the risk of onychomycosis in diabetic patients and increase treatment and/or referral of these patients to a podiatrist. Methods: This project was implemented at Benson Hospital in southeastern Arizona. It involved creation of an online provider module on the risk of onychomycosis in diabetic population and treatment strategies aligning with resources and values of the community. Evaluation was done through pre and post-module surveys utilizing the just-in-time method of training and assessment. Recruitment was done via emails sent to Benson Hospital providers. Findings: Before the module, surveys indicated a lack of consistency of screening of diabetic patients for onychomycosis although providers indicated providing treatment with diagnosis. 8 There was also inconsistency in treatment methods. Post-module results indicated providers had been influenced by the module, which provided them with a greater level of awareness of the issue. After the module, participants stated they would change their approach to onychomycosis in diabetic populations through treatment, referral and patient/provider education. Discussion: Although providers indicated the module was successful in achieving objectives, the project was limited by the small sample size. Future projects of this nature would benefit from in-person recruitment as a method of ensuring provider contact. Additionally, the sample size and dissemination of information would be increased through inclusion of the nursing staff.