| アブストラクト | 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. |
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| ジャーナル名 | Phlebology |
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| Pubmed追加日 | 2018/10/20 |
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| 投稿者 | Davies, Huw Ob; Popplewell, Matthew; Bate, Gareth; Ryan, Ronan P; Marshall, Tom P; Bradbury, Andrew W |
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| 組織名 | 1 Department of Vascular Surgery, University of Birmingham, Birmingham, UK.;2 Medical Innovation Development Research Unit (MIDRU), Heartlands Hospital,;Birmingham, UK.;3 Institute of Applied Health Research, University of Birmingham, Birmingham, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30336756/ |
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