A model for change in delivering community leg ulcer care.

Leg ulcer care has largely been provided by community nursing staff in the UK. However, the treatment of leg ulcers has been accompanied by high cost and poor healing rates. As part of an initiative in a single district of the UK, six community leg ulcer clinics were established and a system of audits implemented to monitor their progress over two years. Improvements were demonstrated in the success of the patient referral system, correct assessment of patients with significant arterial leg disease, effective use of dressings, follow-up to prevent ulcer recurrence, improved nursing education in leg ulcer care, vastly improved healing rates during the first twelve weeks of treatment compared to patients in a pre-study audit, reduced pain and increase in the ability of patients to perform activities inside and outside the home, and a cost reduction from an estimated $680,000 per annum to $250,000 in the study district. The model of care implemented in these community clinics can be adapted to other communities. Priority must be given to auditing outcomes and changes to ensure that the most effective care is delivered in each community.