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International Angiology 2012 December;31(6):550-6


lingua: Inglese

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

Rybak Z. 1, Franks P. J. 2, Krasowski G. 3, Kalemba J. 4, Glinka M. 5

1 Department of Experimental Surgery and Biomaterials Research, Wroclaw Medical University, Wroclaw, Poland; 2 Centre for Research and Implementation of Clinical Practice, London, UK; 3 Politechnika Opolska, KCZ Krapkowice, Poland; 4Estmed Strzelce Opolskie, Poland; 5Varmed Ustroń, Poland


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.

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