德国医疗保健中下肢静脉溃疡的初级护理疾病管理:下肢溃疡护理试点研究结果
Primary Care Disease Management for Venous Leg Ulceration in German Healthcare: Results of the Ulcus Cruris Care Pilot Study.
作者信息
Senft Jonas D, Fleischhauer Thomas, Poß-Doering Regina, Frasch Jona, Feißt Manuel, Awounvo Sinclair, Müller-Bühl Uwe, Altiner Attila, Szecsenyi Joachim, Laux Gunter
机构信息
Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
aQua Institute for Applied Quality Promotion and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany.
出版信息
Healthcare (Basel). 2023 Sep 12;11(18):2521. doi: 10.3390/healthcare11182521.
Despite proven effectiveness, compression therapy is applied in only 20-40% of patients with venous leg ulceration, leading to avoidable chronification and morbidity. The Ulcus Cruris Care project was established to develop a new disease-management concept comparable to existing programs for chronic diseases to support evidence-based treatment of venous leg ulceration. This prospective controlled study assessed its first implementation. Interventional elements comprised online training for general practitioner practices, software support for case management, and educational materials for patients. A total of 20 practices and 40 patients were enrolled in a 1:1 ratio to the intervention and control group. Guideline-conform compression therapy was applied more frequently in the intervention group (19/20 [95%] vs. 11/19 [58%]; = 0.006). For patients with ulcers existing ≤ 6 months, the healing rate at 12 weeks was 8/11 [73%] (intervention) compared to 4/11 [36%] (control; = 0.087). Patients after intervention had higher scores for self-help and education in the PACIC-5A questionnaire (42.9 ± 41.6 vs. 11.4 ± 28.8; = 0.044). Treatment costs were EUR 1.380 ± 1.347 (intervention) and EUR 2.049 ± 2.748 (control; = 0.342). The results of this study indicate that the Ulcus Cruris Care intervention may lead to a significant improvement in care. Consequently, a broader rollout in German healthcare seems warranted.
尽管已证实具有有效性,但只有20%-40%的下肢静脉溃疡患者接受了压迫治疗,这导致了可避免的病情慢性化和发病率增加。设立“下肢溃疡护理项目”是为了开发一种新的疾病管理概念,类似于现有的慢性病项目,以支持下肢静脉溃疡的循证治疗。这项前瞻性对照研究评估了该项目的首次实施情况。干预措施包括为全科医生诊所提供在线培训、为病例管理提供软件支持以及为患者提供教育材料。共有20家诊所和40名患者按1:1的比例纳入干预组和对照组。干预组更频繁地应用符合指南的压迫治疗(19/20 [95%] 对比11/19 [58%];P = 0.006)。对于溃疡存在时间≤6个月的患者,干预组12周时的愈合率为8/11 [73%],而对照组为4/11 [36%](P = 0.087)。干预后的患者在PACIC-5A问卷中的自助和教育得分更高(42.9±41.6对比11.4±28.8;P = 0.044)。治疗费用干预组为1380±1347欧元,对照组为2049±2748欧元(P = 0.342)。这项研究的结果表明,“下肢溃疡护理”干预可能会显著改善护理。因此,在德国医疗保健领域进行更广泛的推广似乎是有必要的。