Leg ulcer point prevalence can be decreased by broad-scale intervention: a follow-up cross-sectional study of a defined geographical population.

In 1988 a cross-sectional epidemiological study was performed in Skaraborg County, Sweden, establishing leg ulcer point prevalence. Based on the results of that study a complete change in the care of leg ulcer patients was brought into practice. The objective of this postal cross-sectional follow-up study was to evaluate the success of the new management strategy. Responding healthcare providers were asked to report all patients with an open wound below the knee that did not heal within a 6-week period after onset of ulceration. Validity of results was ensured by examining 203 randomly selected patients. Based on clinical examination, an assessment of the underlying causes of ulceration was made. The study setting was inpatient and outpatient care in hospitals, primary care and community care within Skaraborg, with a population of 254,111. The response rate was 100% from district nurses, hospital wards and outpatient clinics. Reports were collected from healthcare providers, mainly nurses, in all 15 communities. A total of 621 individual patients with active leg ulcers were identified. Age-adjusted sex ratio of ulcer patients was 1:1.1 (M:F). The median age was 79 years. A total of 507 patients (82%) were older than 64 years. District and community nurses provided care for the majority (88.5%) of patients. The study verified a point prevalence of 2.4/1000 population in 2002 compared with 3.1/1000 in 1988, a 23% decrease in leg ulcer prevalence. Venous insufficiency was still the dominating causative factor, although the number of patients with venous leg ulcers was reduced by 46%. Arterial ulcers had decreased by 23%, while patients with ulcers of diabetic and multifactorial causes were increased. In conclusion, it is likely that this reduction in point prevalence reflects the introduction of the change in management strategy undertaken in the area.