Evaluation of the RAPID technology-enabled care pathway for people with diabetes-related foot problems living in remote and rural settings

Citation

Hall J, Main F, Gorman J, Heaton J, Macfarlane D & MacRury S (2025) Evaluation of the RAPID technology-enabled care pathway for people with diabetes-related foot problems living in remote and rural settings. The Diabetic Foot Journal, 28 (2), pp. 31-38. https://diabetesonthenet.com/diabetic-foot-journal/evaluation-of-the-rapid-technology-enabled-care-pathway-for-people-with-diabetes-related-foot-problems-living-in-remote-and-rural-settings/

Abstract
Aim: People living with diabetes-related foot problems in rural areas have difficulty in accessing diabetes specialist foot services. We aimed to evaluate triage outcomes of a community-based electronic referral (eReferral) and remote video consultation (VC) service in a large rural health board area in comparison with other referral routes. Methods: Data were collected for all referrals to the diabetes specialist foot team over a 27-month period, including demographic data, foot ulcer outcomes and healing times, as well as staff and patient perceptions of the service. Results: The majority of eReferrals were from the most remote areas and 88% of all eReferrals were triaged within the pre-set level of 48 hours. Average estimated distance saved from travelling to the specialist centre for individuals reviewed by VC was 317.7 km. Remission rates (55.5% vs 61.2%, p=0.38) and time to remission (103.7 ± 16.1 days vs 81.0 ± 10.1 days, p=0.21) were similar between eReferral and other routes. Patient perceptions of quality of interaction in VC were similar to in-person consultations. Compared with other routes, staff felt the eReferral pathway was better for ulcer treatment and clinical outcomes and joint VC consultations were particularly useful for collaboration with the specialist foot team. Conclusion: An eReferral pathway and option for VC consultation was associated with reductions in distance travelled, estimated carbon emissions and potential cost savings. There were good levels of patient and staff satisfaction with the pathway and similar levels of ulcer healing. The pathway may be utilised in any environment but is particularly useful in remote and rural areas especially in winter.

Keywords
Foot ulceration; technology-enabled; rurality; specialist foot team

Journal
The Diabetic Foot Journal: Volume 28, Issue 2