Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service

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Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service. / Davies, Huw Ob; Popplewell, Matthew; Bate, Gareth; Kelly, Lisa; Darvall, Katy; Bradbury, Andrew W.

In: Phlebology, Vol. 33, No. 2, 03.2018, p. 84-88.

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Davies, Huw Ob ; Popplewell, Matthew ; Bate, Gareth ; Kelly, Lisa ; Darvall, Katy ; Bradbury, Andrew W. / Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service. In: Phlebology. 2018 ; Vol. 33, No. 2. pp. 84-88.

Bibtex

@article{3f1ee23ce39d430fa21c7a22bdc09e65,
title = "Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service",
abstract = "Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012-June 2013) and an 18-month period commencing six months after (January 2014-June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in chronically underfunded leg ulcer services.",
keywords = "Adult, Aged, Aged, 80 and over, Bandages, Cardiology/standards, Female, Humans, Leg Ulcer/therapy, Male, Middle Aged, Practice Guidelines as Topic, Referral and Consultation, United Kingdom, Varicose Ulcer/therapy, Vascular Surgical Procedures, Wound Healing, Young Adult",
author = "Davies, {Huw Ob} and Matthew Popplewell and Gareth Bate and Lisa Kelly and Katy Darvall and Bradbury, {Andrew W}",
year = "2018",
month = mar,
doi = "10.1177/0268355516688357",
language = "English",
volume = "33",
pages = "84--88",
journal = "Phlebology",
issn = "0268-3555",
publisher = "SAGE Publications",
number = "2",

}

RIS

TY - JOUR

T1 - Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service

AU - Davies, Huw Ob

AU - Popplewell, Matthew

AU - Bate, Gareth

AU - Kelly, Lisa

AU - Darvall, Katy

AU - Bradbury, Andrew W

PY - 2018/3

Y1 - 2018/3

N2 - Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012-June 2013) and an 18-month period commencing six months after (January 2014-June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in chronically underfunded leg ulcer services.

AB - Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012-June 2013) and an 18-month period commencing six months after (January 2014-June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in chronically underfunded leg ulcer services.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bandages

KW - Cardiology/standards

KW - Female

KW - Humans

KW - Leg Ulcer/therapy

KW - Male

KW - Middle Aged

KW - Practice Guidelines as Topic

KW - Referral and Consultation

KW - United Kingdom

KW - Varicose Ulcer/therapy

KW - Vascular Surgical Procedures

KW - Wound Healing

KW - Young Adult

U2 - 10.1177/0268355516688357

DO - 10.1177/0268355516688357

M3 - Article

C2 - 28092206

VL - 33

SP - 84

EP - 88

JO - Phlebology

JF - Phlebology

SN - 0268-3555

IS - 2

ER -