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BMC Health Services Research
Published in: BMC Health Services Research 1/2008

Open Access 01-12-2008 | Research article

Nurse clinic versus home delivery of evidence-based community leg ulcer care: A randomized health services trial

Authors: Margaret B Harrison, Ian D Graham, Karen Lorimer, Elizabeth VandenKerkhof, Maureen Buchanan, Phil S Wells, Tim Brandys, Tadeusz Pierscianowski

Published in: BMC Health Services Research | Issue 1/2008

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Abstract

Background

International studies report that nurse clinics improve healing rates for the leg ulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care.

Methods

Health Services RCT was conducted where mobile individuals were allocated to either home or nurse clinic for leg ulcer management. In both arms, care was delivered by specially trained nurses, following an evidence protocol. Primary outcome: 3-month healing rates. Secondary outcomes: durability of healing (recurrence), time free of ulcers, HRQL, satisfaction, resource use. Data were collected at base-line, every 3 months until healing occurred, with 1 year follow-up. Analysis was by intention to treat.

Results

126 participants, 65 randomized to receive care in their homes, 61 to nurse-run clinics. No differences found between groups at baseline on socio-demographic, HRQL or clinical characteristics. mean age 69 years, 68% females, 84% English-speaking, half with previous episode of ulceration, 60% ulcers at inclusion < 5 cm2 for < 6 months. No differences in 3-month healing rates: clinic 58.3% compared to home care at 56.7% (p = 0.5) or in secondary outcomes.

Conclusion

Our findings indicate that organization of care not the setting where care is delivered influences healing rates. Key factors are a system that supports delivery of evidence-based recommendations with care being provided by a trained nursing team resulting in equivalent healing rates, HRQL whether care is delivered in the home or in a community nurse-led clinic.

Trial registration

ClinicalTrials.gov Protocol Registration System: NCT00656383
Appendix
Available only for authorised users
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Metadata
Title
Nurse clinic versus home delivery of evidence-based community leg ulcer care: A randomized health services trial
Authors
Margaret B Harrison
Ian D Graham
Karen Lorimer
Elizabeth VandenKerkhof
Maureen Buchanan
Phil S Wells
Tim Brandys
Tadeusz Pierscianowski
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2008
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-8-243

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