title: Strategy for the treatment of chronic leg wounds: a new model in Poland.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Experimental Surgery and Biomaterials Research, Wroclaw Medical University, Poland. zrybak@poczta.onet.pl
authors.forename: Z
authors.initials: Z
authors.lastname: Rybak
authors.forename: P J
authors.initials: PJ
authors.lastname: Franks
authors.forename: G
authors.initials: G
authors.lastname: Krasowski
authors.forename: J
authors.initials: J
authors.lastname: Kalemba
authors.forename: M
authors.initials: M
authors.lastname: Glinka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002908:Chronic Disease; D058128:Compression Bandages / Q000191:economics; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D004502:Education, Medical, Continuing / Q000191:economics; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D007318:Inservice Training / Q000191:economics; D007871:Leg Ulcer / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015397:Program Evaluation; D058996:Quality Improvement; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing