Real Life use of Dressings in the Treatment of Leg Ulcers and Diabetic Foot Ulcers

OBJECTIVES: Leg ulcers (LUs) and diabetic foot ulcers (DFUs) can take a long time to heal, with dressings requiring frequent changes. Establishing current treatment pathways and reasoning for changing a care plan, will provide real life understanding regarding the use of dressings and areas providing opportunity to improve patient outcomes and reduce the economic burden of these conditions. The study aimed to establish treatment pathways, incidence of treatment switching, patient outcomes and resource use of patients with a LU or DFU. METHODS: A multi-centre, retrospective, chart examination performed in multiple care settings. The data extracted included wound characteristics, each visit by the patient, and every intervention. Reasons for a change of treatment plan, and infection and healing rates were captured. Reasons for changing treatment were coded and analysed. RESULTS: 7 UK centres provided data from 97 patients, totalling 107 wounds and 1050 visits. 90 (9%) wounds were observed for the first time and 42 (4%) healed wounds not requiring dressings were observed, 189 (18%) changes used the same dressing as previously recorded. This left 729 (69%) instances of treatment switching. Reasons for changes to treatment plan were either Clinical (28%), Patient (5%), External (5%) or No reason (62%). External reasons included available stock and guidance from other clinicians. CONCLUSIONS: 69% of visits resulted in a different type of dressing being applied, with 62% of these changes being made without a reason. The data also suggests superior clinical outcomes are achieved in Randomised Clinical Trials compared to real life. Patients in RCTs receive the same intervention for the trial duration; yet this study finds a switch in nearly 80% of eligible visits. It is theorised therefore that without mandated guidance regarding dressings, current treatment switching practices may continue as observed, with potential adverse outcomes on patient health and quality of life