Nurse clinic versus home delivery of evidence-based community leg ulcer care: a randomized health services trial.
BACKGROUND
International studies report that nurse clinics improve healing rates for the leg ulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care.


METHODS
Health Services RCT was conducted where mobile individuals were allocated to either home or nurse clinic for leg ulcer management. In both arms, care was delivered by specially trained nurses, following an evidence protocol.


METHODS
3-month healing rates.


RESULTS
durability of healing (recurrence), time free of ulcers, HRQL, satisfaction, resource use. Data were collected at base-line, every 3 months until healing occurred, with 1 year follow-up. Analysis was by intention to treat.


RESULTS
126 participants, 65 randomized to receive care in their homes, 61 to nurse-run clinics. No differences found between groups at baseline on socio-demographic, HRQL or clinical characteristics. mean age 69 years, 68% females, 84% English-speaking, half with previous episode of ulceration, 60% ulcers at inclusion < 5 cm2 for < 6 months. No differences in 3-month healing rates: clinic 58.3% compared to home care at 56.7% (p = 0.5) or in secondary outcomes.


CONCLUSIONS
Our findings indicate that organization of care not the setting where care is delivered influences healing rates. Key factors are a system that supports delivery of evidence-based recommendations with care being provided by a trained nursing team resulting in equivalent healing rates, HRQL whether care is delivered in the home or in a community nurse-led clinic.


BACKGROUND
ClinicalTrials.gov Protocol Registration System: NCT00656383.
Harrison
Margaret B
MB
School of Nursing, Queen's University, Kingston, Ontario, Canada. Margaret.B.Harrison@Queensu.ca
Graham
Ian D
ID
Lorimer
Karen
K
Vandenkerkhof
Elizabeth
E
Buchanan
Maureen
M
Wells
Phil S
PS
Brandys
Tim
T
Pierscianowski
Tadeusz
T
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003151:Community Health Centers; D019317:Evidence-Based Medicine; D005260:Female; D006699:Home Care Services; D006801:Humans; D007871:Leg Ulcer / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D009739:Nursing Services; D011788:Quality of Life; D016896:Treatment Outcome