Leg-ulcer care in the community, before and after implementation of an evidence-based service

Harrison, Margaret B.; Graham, Ian D.; Lorimer, Karen; Friedberg, Elaine; Pierscianowski, Tadeusz; Brandys, Tim
May 2005
CMAJ: Canadian Medical Association Journal;5/24/2005, Vol. 172 Issue 11, p1447
Academic Journal
Background: Leg ulcers usually occur in older patients, a growing population for which increasing health care resources are required. Treatment is mainly provided in patients' homes; however, patients often receive poorly integrated services in multiple settings. We report the results of a prospective study of a community-based care strategy for leg ulcers. Methods: International practice recommendations and guidelines were adapted to make a new clinical protocol. The new model, for a dedicated service staffed by specially trained registered nurses, established initial and ongoing assessment time frames and provided enhanced linkages to medical specialists. Data were collected for 1 year before and after implementation; outcome measures included 3-month healing rates, quality of life and resource usage. Results: Three-month healing rates more than doubled between the year before implementation (23% [18/78]) and the year afterward (56% [100/180]). The number of nursing visits per case declined, from a median of 37 to 25 ( p= 0.041); the median supply cost per case was reduced from $1923 to $406 ( p = 0.005). Interpretation: Reorganization of care for people with leg ulcers was associated with improved healing and a more efficient use of nursing visits.


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