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What is the effect of venous leg ulcer cares in the Auckland District Health Board community setting compared to other clinical centres in New Zealand: A retrospective analysis of data from four trials between 2003 to 2019.

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Version 2 2024-04-23, 01:35
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posted on 2024-04-23, 01:35 authored by Mark Infante

ABSTRACT

Aims and objectives: This research will address the effects of venous leg ulcer [VLU] cares in the Auckland DHB community setting compared to four other clinical centres in New Zealand (South Auckland, Waikato, Christchurch, and Dunedin). It will describe the demography by the clinical centre, explore the use of different compression systems, investigate healing outcomes, explore the use of pentoxifylline, and lastly, it will describe how compression hosiery is used after healing. Design: This study was a retrospective, descriptive analysis of data from four New Zealand trials conducted between 2003 to 2019. Methods: The usual-care arm of four New Zealand VLU trials was analysed to describe the demography and the healing outcomes of the Auckland DHB community setting compared to the other clinical centres caring for VLUs. All trials had similar inclusion and exclusion criteria. Results The mean age was similar for all study centres (63.7 years, SD 17.5), with Auckland DHB having one of the population at 66.9 years. Most participants from all the study centres were NZ European (276, 69.1%), with Māori participants having the second-highest ethnicity count at 60 participants (15.2%). Auckland DHB used a wide variety of compression systems, including more short-stretch bandaging (31.3%) than other clinical centres (South Auckland, 12.9%; Waikato, 4.9%; Christchurch, 14.8%; Dunedin, 4.9%). Auckland DHB had larger (3.5cm2, interquartile range [IQR] 1.3cm2 – 9.5cm2) (South Auckland, 2.6 cm2, IQR 1.1 cm2 – 6.6 cm2; Waikato; 2.5 cm2, IQR 1.3 cm2 – 8.3 cm2; Christchurch, 2.3 cm2, IQR 1.1 cm2 – 7.0 cm2; Dunedin, 5.8 cm2, IQR 2.3 cm2 – 10.0 cm2) and older (26 weeks, IQR 11 wks-54 wks) (South Auckland, 19 wks, IQR 10 wks -50 wks; Waikato; 14 wks, IQR 9 wks -30 wks; Christchurch, 17 wks, IQR 10.6 wks – 32.5 wks; Dunedin, 26 wks, 16 wks - 52 wks) VLUs compared to the other clinical centres, only coming behind Dunedin. Auckland DHB also had one of the highest amounts of (16, 22%) hard-to-heal ulcers according to the Margolis Index compared to the other clinical centres (South Auckland, 16, 12.9%; Waikato; 7, 11.5%; Christchurch, 19, 17.6%; Dunedin, 12, 29.3%). Despite this, the healing rates in Auckland DHB (35, 54.7%) were similar to the other clinical centres (South Auckland, 67, 54%; Waikato; 41, 67.2%; Christchurch, 67, 62%; Dunedin, 23, 56.1%) and the use of compression hosiery after healing in Auckland (33, 94.3%) was greater than in all other clinical centres (South Auckland, 47, 70.1%; Waikato; 37, 90.2%; Christchurch, 51, 76.1%; 2 Dunedin, 20, 80.7%). Only one participant in any of the clinical centres was using pentoxifylline. Ethnicity and compression systems had significant associations with the study centres (p-value = <0.001; p-value = 0.004). Sensitivity analysis showed no significant difference with ethnicity and compression systems as co-variates to time to healing (hazard ratio [HR] = 1.06, 95% confidence interval [CI] = 0.743 – 1.497). There was also no significant difference in time to healing with Auckland DHB compared to the other study centres (p-value = 0.771), as shown by the Kaplan-Meier plot. Conclusion: This study showed that Auckland DHB had one of the highest hard-to-heal ulcers compared to the other clinical centres, as identified by the Margolis Index. Despite this, healing rates were similar for all study centres. Lastly, Auckland DHB used a more comprehensive range of compression systems. Implications: This study has identified areas of improvement and the need for future research. The Margolis index should be implemented into routine clinical practice as it is a simple tool that will prompt the proper intervention needed for patients. New care guidance should be amended to recommend the use of pentoxifylline with hard-to-heal patients as it is a fully subsidised medication that has been shown to improve healing rates in chronic VLUs. Lastly, a clinical audit of the district nursing [DN] care in Auckland DHB regarding practices and outcomes will allow to identify areas of improvement.

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