Rybak Z, Franks P J, Krasowski G, Kalemba J, Glinka M
Department of Experimental Surgery and Biomaterials Research, Wroclaw Medical University, Poland.
Int Angiol. 2012 Dec;31(6):550-6.
The aim of the present study was to implement and evaluate a system of care for patients with chronic leg ulceration (CLU) in Poland.
All patients within two defined geographical areas in Poland were identified for inclusion in the study. A model of care was developed based on guidelines, including the appropriate education of health professionals treating patients, access to non-invasive methods to determine the ulcer aetiology, compression therapy in those with proven venous ulceration.
In total 309 patients were identified with CLU at the start of the study (120 men, 189 women). Both regions had a similar profile of patients having a median (IQR) duration of ulceration of 96 (30-168) months. Most (75.7%) patients were assessed using clinical signs and symptoms alone, with a mean (SD) number of treatments per week at 1.8 (1.9) visits. Two years after implementation, the numbers of patients had reduced to 205 (86 men, 119 women) a reduction of 33%. Post implementation more patients were treated at home (49.3% versus 19.5%) with a corresponding reduction in those seen at health centres (35.6% versus 63.3%). The mean (SD) number of visits was reduced to 1.3 (0.7). During implementation the healing rate at 30 weeks improved from 73.3% to 82.9%, with a corresponding reduction in amputations from 6.3% to 2.1%. While the cost per patient was higher post-implementation, the overall cost of treating patients within the service reduced from €3847 to €2913 per week.
The development and implementation of an evidence based system of care for patients with CLU in Poland is both clinically and cost effective. This may be used as a model for other regions of Poland.
本研究旨在在波兰实施并评估一种针对慢性腿部溃疡（CLU）患者的护理体系。
确定波兰两个特定地理区域内的所有患者纳入研究。基于指南制定了一种护理模式，包括对治疗患者的卫生专业人员进行适当教育、采用非侵入性方法确定溃疡病因、对确诊为静脉性溃疡的患者进行压迫治疗。
研究开始时共确定309例CLU患者（120例男性，189例女性）。两个区域的患者情况相似，溃疡持续时间中位数（四分位间距）为96（30 - 168）个月。大多数（75.7%）患者仅通过临床体征和症状进行评估，每周平均（标准差）治疗次数为1.8（1.9）次就诊。实施两年后，患者数量减少至205例（86例男性，119例女性），减少了33%。实施后更多患者在家中接受治疗（49.3%对19.5%），在健康中心就诊的患者相应减少（35.6%对63.3%）。平均（标准差）就诊次数减少至1.3（0.7）次。在实施过程中，30周时的愈合率从73.3%提高到82.9%，截肢率相应从6.3%降至2.1%。虽然实施后每位患者的成本更高，但该服务范围内治疗患者的总成本从每周3847欧元降至2913欧元。
在波兰为CLU患者开发并实施基于证据的护理体系在临床和成本效益方面均具有优势。这可作为波兰其他地区的模式。
