Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice.
Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).
Centre for Research & Implementation of Clinical Practice, 128 Hill House, 210 Upper Richmond Road, London SW15 6NP, United Kingdom.
Peter J
PJ
Franks
Wounds Australia.
Judith
J
Barker
United Lincolnshire Hospitals NHS Trust (ULHT), c/o Pilgrim Hospital, Sibsey Road, Boston, Lincolnshire, PE21 9QS, United Kingdom.
Mark
M
Collier
School of Nursing and Midwifery, NUI Galway, Ireland.
Georgina
G
Gethin
Wound Management and Healing Node, Curtin University, Perth, Australia & Academic Unit of General Practice, Australian National University, Canberra, Australia (Visiting Fellow).
Emily
E
Haesler
Department of Vascular Surgery and Angiology, Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland.
Arkadiusz
A
Jawien
University Hospital Zürich, Department of Dermatology, Gloriastrasse 31, CH-8091 Zürich, Switzerland.
Severin
S
Laeuchli
Barbantini Clinic, Via del Calcio n.2, Lucca, Italy.
Giovanni
G
Mosti
School of Health, University of Applied Sciences Western Switzerland, HES-SO Genève, Avenue de Champel 47, CH-1206 Geneva, Switzerland.
Sebastian
S
Probst
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia.
Carolina
C
Weller