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. 2024 Dec 18;12(24):2552.
doi: 10.3390/healthcare12242552.

Pilot Implementation of a Primary Care Disease Management Concept for Venous Leg Ulceration: Results of a Mixed-Methods Process Evaluation

Thomas Fleischhauer  1 , Regina Poß-Doering  1 , Nina Sander  1 , Gunter Laux  1 , Michel Wensing  1 , Joachim Szecsenyi  1 , Jonas D Senft  1
Affiliations

Pilot Implementation of a Primary Care Disease Management Concept for Venous Leg Ulceration: Results of a Mixed-Methods Process Evaluation

Thomas Fleischhauer et al. Healthcare (Basel). .

Abstract

Background: Within the project "Ulcus Cruris Care", a disease management intervention to improve general practice care for patients with venous leg ulcer was developed, comprising online teaching for practice teams, standardized patient education, and case management. Implementation of the intervention was piloted and evaluated via a process evaluation. This study aims to evaluate contentedness with the intervention, implementation effort, implementation determinants, intervention fidelity, and perceived intervention effects using a mixed-methods process evaluation.

Methods: The mixed-methods process evaluation explored the views of general practitioners, medical assistants and patients regarding the intervention components. Data were collected through semi-structured telephone interviews and a survey questionnaire. Qualitative data were first analyzed inductively, followed by a deductive-inductive approach based on the Theoretical Domains Framework. Survey data were analyzed descriptively.

Results: Participants (n = 21) reported a strong contentedness with the intervention, high intervention fidelity, low implementation effort, and a change in perception of compression therapy as the central treatment element. Healthcare professionals emphasized increased patient education and patient and family involvement. Patients reported feeling better informed and empowered to take an active role in their treatment, primarily due to increased knowledge and skills in compression therapy. As a result, they were more content with their care and reported positive experiences with wound healing since trial participation.

Conclusions: The Ulcus Cruris Care intervention can lead to a noticeable change in knowledge and potentially influence practice teams' approach to venous leg ulcer management, facilitating a significantly more frequent use of compression therapy in VLU care. A confirmatory evaluation of potential effects in a definitive RCT seems warranted.

Keywords: case management; disease management; general practice; leg ulcer; patient education; wound healing.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study design of the process evaluation. GP = general practitioner. MA = medical assistant.
Figure 2
Figure 2
Theorizing analytical approach of the process evaluation. GP = general practitioner. MA = medical assistant. VLU = venous leg ulcer. formula image = increase. formula image = decrease.
Figure 3
Figure 3
GPs’ mean ratings of perceived intervention effects. Likert scale ranging from 1 to 5 (totally disagree = 1, somewhat disagree = 2, partially agree = 3, somewhat agree = 4, totally agree = 5).
Figure 4
Figure 4
MAs’ mean ratings of perceived intervention effects. Likert scale ranging from 1 to 5 (totally disagree = 1, somewhat disagree = 2, partially agree = 3, somewhat agree = 4, totally agree = 5).
Figure 5
Figure 5
Patients’ means ratings of perceived effects of the interventions. Likert scale ranging from 1 to 5 (totally disagree = 1, somewhat disagree = 2, partially agree = 3, somewhat agree = 4, totally agree = 5).
See this image and copyright information in PMC

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