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EWMA2008
Presented at the
18 th Conference
of the European
Wound Management
Association,
14-16 May 2008,
Lisbon, Portugal
Compression therapy
for venous leg ulcers
– how to get more value for money
Abstract
Background: Compression therapy is a time consuming
and often inefficient service delivered by
nurses in homecare.
EWMA guidelines for the management of leg
ulcers and expert opinions seem to have had little
impact on the daily practice.
Hypothesis/aim: Evidence-based guidelines can
be implemented in primary health care and deliver
more value for money. By meeting the standards
you can obtain better patient compliance and
quicker wound healing.
Methods: Six different types of compression, cost
of material and cost of manpower are compared
in three different patient cases. This comparison
is linked to the EWMA standards.
Results: Compression therapy must be kept simple
and must succeed in the hands of a large group
of non-specialised nurses and other healthcare
professionals.
1. Reduce oedema with disposable multilayered
bandages or inelastic lined bandages (use
sub-bandage pressure measuring device) or
elastic bandages with indicators.
2. Proceed to compression hosiery when the
oedema has been treated and the ulcer is less
exudating.
Conclusions: We wonder why the EWMA guidelines
have not been widely implemented and ask
the following question:
Is it due to lack of knowledge or is the reason that
prescribing authorities fail to consider the socio-economical
implications?
INTRODUCTION
In the western world approximately 10% of the
population will suffer from chronic venous insufficiency
and approximately 1% of the population
will develop venous leg ulcers and need compression
therapy (1).
The recommended standards for the treatment
of venous leg ulcers and mixed arterial and venous
leg ulcers are (2):
Superficial venous insufficiency; 60% healed
in 3 months and 15 % recurrences within 1 year
Mixed insufficiency; 40% healed in 3 months
and 40% recurrences within 1 year
Studies have shown that a 97% healing rate can
be obtained in four weeks (3)
In an average community in Denmark the
healing rate for venous leg ulcers is estimated to
be approximately 40% in 12 weeks (3) plus a high
recurrence of up to75% the first year after healing.(4)
The healing time for venous leg ulcers can
be unnecessarily prolonged by many years especially
where compression therapy is ineffective.
These numbers indicate potential room for
improvement. The incidence of venous leg ulcers
in the population will increase, as a consequence
of an increase in the numbers of elderly people
in the decades to come. It is necessary to make
effective improvements in this area, considering
the quality of life for these many patients – as a
study from the southern part of Denmark has
shown (5) Furthermore it is imperative to find
new methods so that the communities get more
value for money, since the major part of the treatment
of venous leg ulcers takes place in the primary
health care sector. ‘New health care issues
– focus on competency development’ – the Danish
communities’ national association (KL) latest
publication along with the Danish government’s
quality reform (www.kvalitetsreform.dk) and the
Danish nurses’ union’s many publications concerning
quality development in the healthcare
system all stress these facts.
A decade ago studies in Sweden showed that approximately
five million dressing changes for leg
ulcers took place per year which is equivalent to a
cost of approximately 1 million kroner, equivalent
to 1333 mill Euro. (6)
�
Science, Practice and Education
Susan F. Jørgensen
Rie Nygaard,
Tissue viability nurses,
KvaliCare
www.kvalicare.dk
suj@zealandcare.dk
EWMA Journal 2008 vol 8 no 3 25