Venous ulcer management in New Zealand: usual care versus guideline recommendations

Abstract

Aim: To compare usual care with key recommendations for venous ulcer management in the New Zealand Guidelines for Care of People with Chronic Leg Ulcers.

Method: A cohort of participants enrolled in the usual care arm of the HALT trial had their management compared to four treatment recommendations: compression (use high compression); dressing selection (use simple dressings); pentoxifylline (trial of treatment if not tolerant of compression or failure to progress with compression alone); and compression hosiery after healing (remain in hosiery after healing to prevent recurrence).

Results: 181 participants were enrolled in the usual care arm, 25 in Auckland, 60 in Counties Manukau, 41 in Waikato, and 55 in Christchurch. Compression--all participants received high compression. Dressings--simple dressings accounted for just 29% of dressings used. Moist dressings and medicated dressings accounted for 35% and 36% of dressings respectively, but 95% of dressing costs. Pentoxifylline--only one participant used pentoxifylline when up to 97 (54%) were candidate patients. Compression after healing--70% of participants healed at 12 weeks used compression hosiery after healing with regional variation in use.

Conclusion: Compression use was consistent with guideline recommendations, although hosiery use after healing could improve. Dressing selection and use of pentoxifylline did not match guideline recommendations. Three of the four guideline recommendations offer opportunities for improving clinical effectiveness, with some potential for cost savings.