Dr. Margaret Harrison, of Queen's School of Nursing, selected the widespread but little-discussed condition to test a new system of community health care delivery. Her initial study, conducted in the Ottawa region, showed that healing rates more than doubled; nursing visits dropped by almost one-third, and individual supply costs decreased by more than half.
That study will now be expanded to produce evidence about which type of compression bandaging is best for people receiving care at home. The new, randomized controlled trial is funded by the Canadian Institutes of Health Research (CIHR) and will run for three years in several Ontario regions including Kingston. To date, it is the largest Canadian wound care trial ever undertaken.
"Leg ulcers are a chronic and debilitating condition for people, some of whom end up requiring home care for years," says Dr. Harrison. "Since we know from research what needs to be done to heal venous leg ulcers [which account for about two-thirds of cases], this seemed an ideal area for implementing an ‘evidence-based protocol': a way of ensuring that current research gets put into practice."
With support from the Ottawa-Carleton Community Care Access Centre (CCAC) and Ontario Ministry of Health career scientist start-up funds, Dr. Harrison's nursing team began by monitoring people receiving home care for venous leg ulcers. The first phase of their investigation found:
- Only 40% were receiving the most effective treatment (compression bandages)
- less than 50% had received a full assessment prior to treatment
- 70% were being treated with antibiotic ointments, although no infection had been documented
- an average of 19 different nurses visited with any one client, while 40% of people received daily, or twice daily visits (compression bandages usually require once or twice weekly visits)
Introduced in the next phase of the study, the new management protocol involved standard assessment and follow-up by a team of nurses trained in leg ulcer assessment and management, who then worked closely with specialist physicians. A strategic alliance was formed between the research team, the health care providers, and the community decision-makers to implement this approach.
"It was ‘back to the future' with nurses taking charge of their practice with community wound care, and having physician back-up for complicated or non-healing cases," says Dr. Harrison. "New technologies don't need to change that. Integrating the practice of nursing with the physicians who order this therapy just makes sense in terms of appropriate use of nurses and medical specialists."
Dr. Harrison says she would have been happy just to learn that the new system was more effective and no more costly. "The fact that it is actually less costly is an unexpected bonus," she says. "This is a perfect instance of where more money is not needed, but we need to do things differently. In this case nurses with a new community service model were able to deliver more effective, less expensive care," she says.
Other communities including Kingston, Kitchener-Waterloo and London, Ontario are now implementing the best practice protocol and will participate in the compression bandaging study.
Dr. Harrison reported on her findings earlier this year at a World Health Organization (WHO) meeting on integrated care, in Barcelona, Spain. An abstract of her research appears in an upcoming edition of the International Journal of Integrated Care.
Leg Ulcer Facts
- Leg ulcers are open sores that develop below the knee, usually due to poor blood circulation
- The most common type are venous ulcers, where blood return from the leg is compromised
- Leg ulcers affect 1.8% of the population over age 25, and 75% occur in people aged 65+
- When not treated properly 60% of ulcers last longer than 6 months; 33% last longer than one year
Contacts:
Nancy Dorrance, Queen's News & Media Services, 613.533.2869
Nancy Marrello, Queen's News & Media Services, 613.533.6000 ext. 74040