102-OR: Barriers to Diabetic Foot Care in Urban Safety-Net Hospital Free

We explored barriers to foot care in a disadvantaged population using surveys of patient perceptions on barriers and self-care. Participants were recruited from an outpatient diabetes clinic at a safety-net hospital in Atlanta, Georgia from 2021-2022 and stratified into two groups: Complications, defined as patient history of foot ulcer or amputation and No Complications, defined as no history of ulcer or amputation. The survey addressed patients' experience in daily foot care and barriers to care. A composite score was created for barriers to foot care comprised of financial and transportation barriers, access to providers, understanding of foot care, and ability to reach feet. Logistic regression was utilized to perform univariate and multivariate assessments adjusting for race, gender, age, employment, and education. Among 80 participants 39% had complications and 61% had no complications. As compared to patients without complications, those with complications were younger (55 yo vs 60, p=0.067) and more often male (63% vs 40%, p=0.04). Both groups were comprised primarily of non-Hispanic Black participants (77% and 94%). Those with complications had longer diabetes duration, > 10 years (64% vs 37%, p=0.015), lower education level, no high school/GED degree or less (54% vs 20%m p=0.003) and lower employment status (p=0.003). Those with complications were more likely to have had discussions about foot care with health care providers (97% vs 74%, p=0.027) and professional examination of their feet (p<0.0001). People with complications were more likely to experience delays in care due to transportation problems (68% vs 39%, p=0.0116). Patients with complications had eight fold greater odds of reporting composite of barriers to care in both unadjusted and adjusted models (unadjusted OR 8.3, 95% CI: 2.5, 27.3; adjusted OR 9.4, 95% CI 1.8, 49.2). Despite having greater focus on foot care in the healthcare setting, patients with foot ulceration or amputation experienced greater barriers to care.