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Quality of care - not setting - key to wound healing

Quality of care - not setting - key to wound heali
Photo: Wound care
People receiving evidence-based wound care at home for venous leg ulcers achieved similar healing rates to those attending a specialist wound care clinic, new research shows.

Bolton Clarke Senior Research Fellow Rajna Ogrin said while community home nursing participants had more risk factors that potentially reduced the likelihood of wound healing, the research showed structured, evidence-based in-home care provided by nurses could achieve comparable healing rates to specialist clinics.

“Chronic venous leg ulcers are a common health problem, with the prevalence rising with increasing age,” Dr Ogrin said.

“Many people with these ulcers receive wound care at home due to difficulty accessing clinics.”

Venous leg ulcers are associated with negative impacts on physical, psychological and social wellbeing and financial burden, leading to lower quality of life and significant costs to the health system.
In Australia, management of leg ulcers is provided by a range of healthcare professions including GPs, medical and surgical specialists and community nurses. Care can also be provided in a variety of settings including at home, in GP or specialist clinics or in hospital.

The fragmented nature of the system means wound treatment can be provided by up to 13 different treatment providers within a 12-month period.

Up to 68 per cent of home nursing care involves the provision of wound care.

Dr Ogrin said in this study, a collaboration with Queensland University of Technology (QUT), data was used from 103 participants recruited from specialist clinics in Queensland, and 98 home care clients in metropolitan Melbourne.

All participants received care based on evidence-based practice guidelines for venous leg ulcer management. All home care registered nurses had undergone wound management training and a research nurse was available to provide additional support.

While wound characteristics were not significantly different between the home care and clinic groups, risk assessment scores for delayed healing were significantly higher in the home care group, indicating more risk factors for delayed healing in this group.

“Interestingly, despite the higher number of potential contributors to delayed healing, healing rates between the homecare and clinic participants were the same,” Dr Ogrin said.

“Participants in the homecare setting also reported experiencing lower levels of pain than clinic participants.”

She said the research supported earlier Canadian research suggesting the quality of care, including a standard approach using trained nurses with appropriate equipment, was more important than the location of care for healing outcomes.

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