Publication of UK NICE Clinical Guidelines 168 has not significantly changed the management of leg ulcers in primary care: an analysis of The Health Improvement Network database

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@article{c8feef0434cc4b5486b30b2b4cc95b4e,
title = "Publication of UK NICE Clinical Guidelines 168 has not significantly changed the management of leg ulcers in primary care: an analysis of The Health Improvement Network database ",
abstract = "Background: NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. Aim: To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. Methods: An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. Results: We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p¼0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. Conclusions: Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations. ",
keywords = "leg ulceration, ulcer, The Health Improvement Network, primary care, NICE, guidelines",
author = "Huw Davies and Matthew Popplewell and Gareth Bate and Ronan Ryan and Tom Marshall and Andrew Bradbury",
year = "2018",
month = oct,
day = "18",
doi = "10.1177/0268355518805658",
language = "English",
journal = "Phlebology",
issn = "0268-3555",
publisher = "SAGE Publications",

}

RIS

TY - JOUR

T1 - Publication of UK NICE Clinical Guidelines 168 has not significantly changed the management of leg ulcers in primary care

T2 - an analysis of The Health Improvement Network database

AU - Davies, Huw

AU - Popplewell, Matthew

AU - Bate, Gareth

AU - Ryan, Ronan

AU - Marshall, Tom

AU - Bradbury, Andrew

PY - 2018/10/18

Y1 - 2018/10/18

N2 - Background: NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. Aim: To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. Methods: An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. Results: We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p¼0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. Conclusions: Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations.

AB - Background: NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. Aim: To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. Methods: An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. Results: We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p¼0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. Conclusions: Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations.

KW - leg ulceration

KW - ulcer

KW - The Health Improvement Network

KW - primary care

KW - NICE

KW - guidelines

U2 - 10.1177/0268355518805658

DO - 10.1177/0268355518805658

M3 - Article

JO - Phlebology

JF - Phlebology

SN - 0268-3555

ER -