Authors (including presenting author) :
YIP KYL(1), Wu WSF(1), Ho CK(1), CHAN BY(1), LI CCD(1), LEUNG MFD(1), CHAN SLD(1), LI YC(1), LEUNG SH(1), WONG SM(2)
Affiliation :
(1)Family Medicine and General Out-patient Department, Kowloon Central Cluster; (2)Central Nursing Department, Queen Elizabeth Hospital;
Introduction :
Venous leg ulcers (VLUs) always known as “hard to heal” wound, which contributed 14.5% of wound types in KCC GOPC second tier wound clinic. VLUs require longer healing time and more dressing attendances and advance skill for traditional compression bandaging treatment. Compression bandaging is the gold standard of VLU treatment, however, compliance issue linked with pain tolerance and personal hygiene factors. Besides, measurement of ABPI is essential for initiation of compression therapy which require higher skill training and is rather time consuming, which would commonly not facilitate in high workload general out-patient setting. A non-experimental cross-sectional study conducted in 2019-2023, on 70 patients with venous leg ulcers suggested the early application of 3-layer tubular bandage at the initial phase of wound care reduces treatment cost, ease to apply empowers patient engagement and improve treatment compliance, improves clinical outcomes and reduces overall GOPC dressing attendances in primary healthcare setting.
Objectives :
To evaluate the effectiveness of early application of Three-layer tubular bandage for patients with venous leg ulcers in primary care setting.
Methodology :
1. Introduction of automated ankle brachial pressure index measuring device (ABPIMD) to facilitate assessment of eligibility to apply compression therapy, which is a gold standard to cure venous leg ulcers.
2. Primary healthcare nurses check ankle brachial pressure index (ABPI) on initial wound dressing attendance for patient with VLUs
3. Initiate 3LTB and provide education to eligible patients
4. Measure clinical 4 outcomes, including wound size, ankle circumference, pain score and treatment compliance, on Week 0, week 2 and Week 4
Result & Outcome :
A total of 70 patients recruited in 10 KCC GOPCs joined the study in September 2020 to April 2023. 65 of them completed both pre- and post-evaluations on Week 4. 89.47% (n=51) of the patients had treatment compliance more than 8 hours per day at week 2 and week 4 after the intervention. Significant decrease in ankle circumference, sixty-five patients e was found after the intervention using Paired samples t-test (diff = -3.48 cm, p < 0.001). For wound size (length * width), sixty-four patients completed both pre- and post-evaluations. 31.25% (n=20) of the patients healed within 4 weeks after the intervention. The mean value was 7.08 cm2 at baseline and 2.78 cm2 at week 4. Significant decrease was found after the intervention using Paired samples t-test (diff = -4.30 cm2, p < 0.01). For pain intensity NRS, sixty-one patients completed both pre- and post-evaluations. The mean score was 4.72 at baseline and 2.03 at week 4. Significant decrease was found after the intervention using Paired samples t-test (diff = -2.69, p < 0.001). Compared with the group with HT, the pain intensity NRS had shown more improvement in the group without HT (diff = -2.14 vs -3.54, p < 0.05). The study finding suggested, with early application of the three-layer tubular bandage at initial GOPC dressing attendance, 3 clinical outcomes of patients with venous leg ulcers were significantly improved, (i) ankle circumferences decreased, (ii) wound size decreased and (iii) pain score improved with high patient treatment compliance of 89.47% over the 4 week study period. Automated ABPIMD allows early assessment of patient in GOPCs for early compression intervention during onset phase of ULVs. High patient compliance on 3LTB application suggested 3LTB would be more tolerable and convenient to maintain personal hygiene, especially in tropical climate conditions in Hong Kong. Treatment cost is more economic compare to traditional compression bandaging and balance with less professional care attendance need. Early application of the 3-layer tubular bandage in primary care setting achieve higher clinical efficiency and promote patient participative care in long run.
