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SOCIO-ECONOMICAL ASPECTS
In order to create an overview of the cost of different
compression treatments we have calculated the costs of six
different types of compression bandages compared by three
different theoretical patient categories (figure 4).
The calculation is carried out in the period from the
2nd to the 6th week of treatment where we assume that
the oedema has been efficiently treated with compression
bandages and the ulcer has reached a moderate exudate
level (as photo).
For the comparison we have used the products shown in
figure 5.
The comparison shows that the costs of using the various
types of compression differ widely. The smallest difference
lies in the choice of compression – the largest difference
occurs due to the difference in personnel time spent. This
has previously been shown in a cost benefit analysis using
multi-layer bandages in the primary healthcare sector. (15)
It is of course essential for the expenses that the healing
rate is high.
Figure 5
Inelastic bandage disposable
Actico from Activa Healthcare
Inelastic bandage non disposable
Comprilan from Smith & Nephew
Elastic bandage
Dauer from Lohmann & Rauscher
Multi-layer bandage
ProGuide from Smith & Nephew
Hosiery Kit Liner + stocking
Activa Hosiery Kit from Activa
Hosiery class 3 (3C)
Sigvaris 503 from Simonsen & Weel
Science, Practice and Education
Transportation is one of the major aspects of the nursing
time consumption. It makes a difference whether the
treating person walks from flat to flat in an apartment
block or drives many kilometres by car from house to
house. The extent of the problem is even larger for the
distances between patients on the Faroe Islands or in the
outer reaches of our neighbouring countries Norway, Sweden
and Finland.
It is evident that if you follow the EWMA guidelines an
economical advantage is obtained. (7) Multi-layer bandages
or hosiery are the best choices.
DISCUSSION
Based on this study, EWMA guidelines, economical calculations
and the results by Jünger, one might suggest
handling the issues around compression therapy in venous
ulcers as follows:
1. Reduction of oedema by using multi-layer bandage
systems
2. Patients who do not tolerate multi-layer bandage
systems: use inelastic or elastic bandages with indicators
or applied with sub-bandage-pressure measuring
device.
As soon as the UE is slim, the oedema has disappeared
and the ulcer exudate has decreased, measure the limb and
apply the hosiery for ulcer treatment. Stockings ensure the
highest safety. Stockings cannot be applied with a wrong
sub-bandage pressure since the hosiery has been measured
individually. Hosiery is efficient and sustains pressure over
time, is economical to use and gives the highest degree of
compliance. Many patients can often manage the stocking
themselves either with an application system or by using
a two stocking system. Often a carer, who is helping the
elderly with other things as well, can help with the application.
The patients can use normal footwear and hosiery
is more discrete to wear than other types of compression,
which carries the additional benefit of improved patient
self esteem. (body image)
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These cohesive bandages are new on the Danish Market. Can be worn up to one week
and do not need washing. A padding layer under the bandage is required.
The bandages are to be changed every 3rd day or more frequently (8).
The bandages need to be washed at every change.
The bandages have to be taken off at night due to high resting pressure.
The bandages need washing at approximately every 3rd changing or when stained.
To be applied in the morning before the patient gets out of bed.
The package includes a foam bandage for the wound.
The multi-layer bandage can be kept on for up to one week and is disposable.
The kit is new on the Danish market. It consists of a 10 mmHg liner + 30 mmHg
stocking. The advantage of this combination is that the patient can sleep with the liner
on – keeping the wound bandage in place – and maintaining a 10 mmHg pressure at
night. This solution also provides the advantage of the stocking being easier to apply
when the smooth liner is in place first.
An application system is needed when putting this hosiery.
In the example we have used easy glide.
EWMA Journal 2008 vol 8 no 3 29