Towards a Model of Care for Chronic Leg Ulcer: Lessons Learned from Studies in Scotland

Abstract

Aim: To highlight the need for a different model of care delivery for chronic leg ulcer. Method: Analysis of data from the Scottish Leg Ulcer Trial and from surveys of leg ulcer care provision among General Practitioners, community nurses and health boards. Synthesis: General Practitioners and community nurses report serious deficiencies in education, training, protocols, equipment and support from the Acute sector. The Scottish Leg Ulcer Trial in a population of 2.65 million showed three-month healing rates of 30% with no improvement after dissemination of National (SIGN) Guidelines even when supplemented by a nationwide nurse training programme. Individual community nurses cared for an average of 1.5 ulcer patients per year. The more chronic the ulcer the poorer the healing rates. Only 17% of Scottish Teaching hospitals or District General hospitals provide a specialist led leg ulcer service. Conclusions: In the population at large, healing rates for leg ulcer are unacceptably low. Individual community nurses do not see enough leg ulcer patients to acquire or sustain the necessary clinical skills. Very few acute hospitals provide leg ulcer services. A new model of leg ulcer care is urgently required centred on multi-disciplinary teams, working in the interface between primary and secondary care, whose prime objectives should be prevention and early intervention. As an