Strategy for the treatment of chronic leg wounds: a new model in Poland

Int Angiol. 2012 Dec;31(6):550-6.

Abstract

Aim: The aim of the present study was to implement and evaluate a system of care for patients with chronic leg ulceration (CLU) in Poland.

Methods: All patients within two defined geographical areas in Poland were identified for inclusion in the study. A model of care was developed based on guidelines, including the appropriate education of health professionals treating patients, access to non-invasive methods to determine the ulcer aetiology, compression therapy in those with proven venous ulceration.

Results: In total 309 patients were identified with CLU at the start of the study (120 men, 189 women). Both regions had a similar profile of patients having a median (IQR) duration of ulceration of 96 (30-168) months. Most (75.7%) patients were assessed using clinical signs and symptoms alone, with a mean (SD) number of treatments per week at 1.8 (1.9) visits. Two years after implementation, the numbers of patients had reduced to 205 (86 men, 119 women) a reduction of 33%. Post implementation more patients were treated at home (49.3% versus 19.5%) with a corresponding reduction in those seen at health centres (35.6% versus 63.3%). The mean (SD) number of visits was reduced to 1.3 (0.7). During implementation the healing rate at 30 weeks improved from 73.3% to 82.9%, with a corresponding reduction in amputations from 6.3% to 2.1%. While the cost per patient was higher post-implementation, the overall cost of treating patients within the service reduced from €3847 to €2913 per week.

Conclusion: The development and implementation of an evidence based system of care for patients with CLU in Poland is both clinically and cost effective. This may be used as a model for other regions of Poland.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amputation
  • Chronic Disease
  • Compression Bandages* / economics
  • Cost-Benefit Analysis
  • Delivery of Health Care, Integrated
  • Education, Medical, Continuing* / economics
  • Female
  • Guideline Adherence
  • Health Care Costs
  • Health Knowledge, Attitudes, Practice*
  • Home Care Services
  • Humans
  • Inservice Training* / economics
  • Leg Ulcer / diagnosis
  • Leg Ulcer / economics
  • Leg Ulcer / epidemiology
  • Leg Ulcer / therapy*
  • Limb Salvage
  • Male
  • Medical Audit
  • Middle Aged
  • Poland / epidemiology
  • Practice Guidelines as Topic
  • Prevalence
  • Program Evaluation
  • Quality Improvement
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Wound Healing