Cultura

Integrating Lifelong Primary Care, Emergency Response, and Mental Health Support: A Comprehensive Multidisciplinary Approach to Improving Patient Outcomes

VOLUME 22, 2025

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Fahad Abdullah Aljarboa, Farhan Mutlaq Alenezi, Mohammed Ibrahim Alsaleem, Sultan Abdullah Haddadi, Meshal Salem Alanazi, Ali Khalid Albawardi, Abdulrahman Mutlaq Almutairi, Waleed Hussain Khubrani
Talal Hathal Alburayk, Faris Mohammed Alqahtani, Turki Yahya A Awaji, Bashair Aldoukhi, Marwa Alghamdi, Mada Batayib, Amal Almutairi

Abstract

Modern healthcare systems face an escalating challenge: patients are living longer, presenting with greater complexity, and requiring care that spans multiple clinical domains simultaneously. The traditional model of siloed, specialty-specific care is increasingly inadequate to address the interconnected realities of chronic disease, mental health comorbidity, and acute crisis. This study explores the conceptual and practical foundations of a unified multidisciplinary framework that integrates lifelong primary care, emergency response capacity, and mental health support into a coherent model of patient-centered care. Drawing on current evidence across primary care implementation, surge capacity planning, psychiatric-medical comorbidity management, lifestyle medicine, and multidisciplinary team models, this review argues that meaningful improvements in patient outcomes are only achievable when these domains are treated not as parallel systems but as mutually reinforcing components of a single, adaptive care continuum. Key themes include the role of health equity in primary care delivery, the critical importance of mental health integration, the operational demands of hospital surge response, and the evidence supporting structured multidisciplinary collaboration. The study concludes with a proposed framework for operationalizing this integration at both the institutional and system levels.

Keywords : .
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty