Assessing Venous Ulcer Population Characteristics and Practices in a Home Care Community
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H ospital restructuring and downsizing has caused an increased demand for community care. These developments, in combination with a shortage of registered nurses, has focused attention on ways to provide more effective and efficient care. Inappropriate management of a chronic health problem such as venous leg ulcers is expensive, both in terms of human suffering and resources such as community nursing services. District or home care nurses are recognized as the key professionals involved in leg ulcer management in the community.1-4
Information about the problem of venous leg ulcers in Canada is limited. Studies that profile individuals with leg ulcers have been undertaken in other western countries, but whether findings from these studies can be generalized to the Canadian population is not known.1,5-7 The first step in planning and developing an evidence-based leg ulcer service is to fully assess the population for whom the service is intended. Profile information was needed on this population and on the current community care provided. The actual number of individuals with venous leg ulcers, issues of health risk, health needs, and resource use have implications for planning and resource allocation.8 Population profile information on clinical, socio-demographic, and circumstance-of-living factors can serve both as a planning and evaluation baseline for improving outcomes.
In one Ontario region, population information was required to determine the appropriateness of developing a new community leg ulcer service similar to successful nurse-led clinics in the UK.9-12 Before developing the new leg ulcer service, the magnitude of the problem of leg ulcers had to be determined. A Regional Prevalence and Profile Study (RPP) was conducted in a large, mixed urban and rural region in Ontario.13 In the RPP study, researchers identified the number of individuals in the region with a leg ulcer (all etiologies) and generated a general characteristics profile. Individuals receiving care from home care, tertiary care, long-term care, and physician family practices were included.
People with venous ulcers require specific management and to that end were the focus of a second more comprehensive profile study. A secondary analysis was conducted on the cohort with venous disease assessed during the RPP. The objective of this Venous Leg Ulcer Study (VLU) was to describe the cohort of individuals with leg ulcers of venous etiology who received care from one large not-for-profit home nursing agency that provided 78% of the leg ulcer home care in one Ontario region during March 1999.
Venous leg ulcers are a chronic and often recurring condition. For afflicted individuals, physical, psychological, and economic consequences of this chronic disease frequently result in premature disability, reduced work productivity, and a loss of independence.14 The associated healthcare costs are also substantial. In the US, the estimated annual healthcare expenditures for venous disease are between $1.9 and $2.5 billion.4
The point prevalence of venous leg ulcers ranges from 0.6 to 1.6 per 1,000 for the total adult population, increasing to between 10 and 30 per 1,000 in the population over the age 85 years.1,5,7 Wide variation exists in the studies on the percentage of leg ulcers with a predominantly venous etiology, with a range of 37% to 81%.1,5-7,15-18 Studies conducted in the UK in the 1980s reported higher venous rates because of the exclusion of isolated foot and toe ulcers. Ulcers in these locations tend to be nonvenous in origin.1,6
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