Authors' objectives:

This report addresses the following questions:

1. Is leg ulcer care satisfactory at present?

2. If not, what improvements are desirable?

3. How might these be implemented and how much would they cost?

Authors' recommendations: 1. Leg ulcer care is not satisfactory at present: service provision is variable and treatment use is sub-optimal partly as a consequence ofinadequate assessment. These three factors have been reflected historically in disappointing healing and recurrence rates for leg ulcers. 2. Improvements desirable: lack of equipment, training and education were recently identified by Scottish community nurses as major constraints to practice, along with drug tariff limitations and poor patient compliance. We would agree that: (a) structured nurse training and postgraduate updates in assessment for treatment or referral; and (b) access to/provision of Doppler ultrasound is necessary to allow improved standards of care. (c) Changing the structure of service provision (eg introducing dedicated clinics) may help, depending upon baseline characteristics of existing services and local population. 3. Implementation and costs: the direct costs of leg ulcer care, including community nurse time, would be reduced by: (a) the use of a narrower range of cheaper dressings to treat the ulcer; (b) wider appropriate use of compression bandaging; which in turn requires: (c) equipment and training for assessment, treatment and referral. Better dressing and bandaging would result in fewer changes, fewer nurse visits, faster healing and reduced costs; (d) provision of community leg ulcer clinics where no dedicated services currently exist as another option, independent of training issues. We believe there is an opportunity to improve the care of a large group of patients while reducing the costs of that care.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.nhsconfed.net/shpic/doc06.htm

Year Published: 1996

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

Organisation Name: Scottish Health Purchasing Information Centre

Copyright: Scottish Health Purchasing Information Centre