Huw Ob Davies1, Matthew Popplewell1, Gareth Bate1, Ronan P Ryan2,3, Tom P Marshall2,3, Andrew W Bradbury1. 1. 1 Department of Vascular Surgery, University of Birmingham, Birmingham, UK. 2. 2 Medical Innovation Development Research Unit (MIDRU), Heartlands Hospital, Birmingham, UK. 3. 3 Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Abstract
BACKGROUND: NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. AIM: To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. METHODS: An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. RESULTS: We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p = 0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. CONCLUSIONS: Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations.
BACKGROUND: NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. AIM: To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. METHODS: An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. RESULTS: We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p = 0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. CONCLUSIONS: Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations.
Entities:
Keywords:
Leg ulceration; NICE; The Health Improvement Network; guidelines; primary care; ulcer
Authors: Francine Heatley; Layla B Saghdaoui; Safa Salim; Sarah Onida; Manj S Gohel; Alun H Davies Journal: Phlebology Date: 2020-07-28 Impact factor: 1.740