student research day - Case Western Reserve University School of ...

Tristan Klosterman
Improving Diabetic Foot Screening in an Urban Dominican Republic Clinic
Tristan Klosterman, Kelly Casteel, Alex Marcotty, Lauren Chmielewski and Dr. Neuhauser
Biostatistics, Epidemiology, Family Medicine
Case Western Reserve University, School of Medicine
BACKGROUND: Poor urban clinics present unique problems and opportunities in addressing health concerns
through intervention. Diabetic complications of the feet are a particularly relevant concern in the Dominican
Republic where chronic care access can be poor. Physicians and health care staff may also not be aware of foot
exam guidelines to prevent such complications. OBJECTIVE: The objective was to increase the number of foot
exams given in an urban shanty - town clinic (FEDOPO) in the Santo Domingo suburb of Guaricano through
education of physicians and staff of the importance and necessity of the exams. METHODS: It was originally
proposed to obtain information from thirty diabetic patient visits regarding whether or not the physician did a foot
exam. Following this, educational intervention would be given to physicians and support staff through the means of
a pamphlet describing the importance of exams in the prevention of morbidity and mortality. In addition, posters
would be displayed in order to reinforce the information. Following the intervention, thirty encounters would again
be observed to see if patients were given exams. The data would be analyzed for statistical significance. RESULTS:
The characteristics of the clinic prevented the implementation of the project. It was discovered, to the
astonishment of our adviser, that diabetic patients were referred to another location. The reasons included an
inability to follow up with chronic care patients due to a lack of medical records and the incompleteness of patient
encounter documentation as well as a lack of blood sugar monitoring equipment and an inability of the local lab to
respond to acute emergency situations where blood sugar readings would be essential. This made the procurement
of the data impossible. This information was obtained through extensive physician interviews as a modification of
the project. CONCLUSIONS: The proposed site was not able to meet the demands of the research proposal. Faults
in the organization of the clinic and miscommunications between the clinic director and the research adviser
prevented the implementation as planned. However, much was obtained in regards to the barriers to research and
interventions in poor urban clinics. Medical records and fundamental equipment that are available in most modern
clinics may deeply impact the quality of delivered health care as well as hinder solutions and research.
46