Kerstein M D, Gahtan V
Department of Surgery, Mount Sinai Medical Center-NYU School of Medicine, NY 10029-6574, USA.
Ostomy Wound Manage. 2000 Jun;46(6):22-6, 28-9.
A longitudinal study involving 81 patients with venous ulcers was conducted to explore the outcomes and cost of wound care in a home healthcare (HHC) setting and an outpatient care setting. Ulcers were managed with a saline gauze or hydrocolloid dressing and compression hosiery, or covered with an Unna's boot. Outcomes did not vary between physician's office and home care. Patients preferred home care, but costs and charges were much higher for HHC than for patients managed in the physician's office. Recurrence rates and costs varied greatly. Eighty-eight percent of ulcers in the saline dressing group did not heal or recurred compared to 21% of ulcers in the Unna's boot and 13% of ulcers in the hydrocolloid dressing group. The data also suggest hydrocolloid dressings are more cost-effective than Unna's boot or saline-gauze dressings. Controlled clinical studies to ascertain the cost-effectiveness of venous ulcer care in different patient care settings and the use of different treatment modalities, as well as care system oriented toward outcome for the patient rather than service, design, and distribution, are needed.
一项针对81名静脉溃疡患者的纵向研究开展，以探究在家庭医疗保健（HHC）环境和门诊护理环境中伤口护理的结果及成本。溃疡采用盐水纱布或水胶体敷料及加压袜进行处理，或用Unna靴覆盖。在医生办公室和家庭护理之间，结果并无差异。患者更倾向于家庭护理，但HHC的成本和收费比在医生办公室接受治疗的患者高得多。复发率和成本差异很大。盐水敷料组中88%的溃疡未愈合或复发，相比之下，Unna靴组为21%，水胶体敷料组为13%。数据还表明，水胶体敷料比Unna靴或盐水纱布敷料更具成本效益。需要进行对照临床研究，以确定在不同患者护理环境中静脉溃疡护理的成本效益以及不同治疗方式的使用情况，同时还需要建立以患者结局而非服务、设计和分配为导向的护理系统。
