Variations in the referral of people with diabetic foot ulceration for specialist management: are we missing something?
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For over three decades, there has been growing evidence that the delayed referral of people with diabetes and foot ulceration to specialist multidisciplinary teams (MDTs) for the management of this condition negatively impacts on its outcomes (MacFarlane and Jeffcoate, 1997; Prompers, 2008; National Diabetes Footcare Audit, 2019). There are continuing calls for this issue to be addressed by way of the implementation of educational strategies (Garcia-Klepzig et al, 2018), refining referral pathways (Meloni et al, 2019) and simplified access to facilities offering specialist MDT care (Barker, 2015). However, extant studies often lack full explanations as to why referral timeframes vary at international, national and individual referrer levels. One reason for this may be the absence of in-depth qualitative data obtained from the multiple healthcare professionals to whom people first present with this condition. This pilot study highlights the need to consider perspectives of referrers when attempting to explain differences in referral timeframes across differing healthcare contexts.