Journal of Community Nursing - page 107

2013,Vol 27, No 4
he recent and ongoing changes
to the NHS were instigated to
absorb the increasing costs of
an ageing population: the NHS needs
to save £15–20 billion by the end of
2013/14 for reinvestment into frontline
services (Department of Health [DH],
2010a; 2010b).
The Quality, Innovation,
Productivity and Prevention (QIPP)
agenda sets the challenge for
clinicians to contribute to these
savings by improving productivity
and eliminating waste, while
ensuring clinical quality and placing
the patient at the centre of care (DH,
2010a; 2010b).
On an individual level, this means
that we each need to look at our daily
practice and identify where we can
make changes that will not only lead
to better care for our patients, but
also improve clinical effectiveness
and result in cost-savings. This is
a personal, professional and moral
responsibility, as it will allow us to
free up resources that can be used to
treat more patients, more effectively
(DH, 2010a).
For those of us treating patients
with wounds and oedema,
compression therapy is a key area
where the principles of the new NHS
can be applied.
Posnett and Franks (2007)
estimated that there are between
70,000 and 190,000 individuals in the
UK with an open ulcer at any time,
with more than 100,000 new ulcers
developing annually; by 2025 this
figure could reach 148,000.
Similarly, chronic oedema has
been estimated to have the same
incidence as leg ulceration in the UK,
affecting over 100,000 people (Moffatt
et al, 2003).
at least £168–£198m per year (Posnett
and Franks, 2007).
These costs were calculated
using clinical trial data in which
treatment was prescribed correctly
and monitored. Sadly, in reality, this is
often not the case (Posnett and Franks,
2007), so these costs are likely to be
much higher.
Compliance and concordance are
frequently highlighted as challenges
that contribute to the economic cost
of leg ulcer management (Anderson,
2012) , with patients who are non-
concordant with compression being
at risk of experiencing disease
progression, delayed healing,
worsening of symptoms and
development of complications, all
of which can send the costs of care
soaring (Bianchi and Timmons, 2008).
The consequences of disease
progression can also have a
catastrophic impact upon the lives of
patients and their families, in terms
of reduced quality of life, yet these
personal costs are often overlooked
(Charles, 2008).
Patients that have difficulty with
compression therapy are frequently
encountered, and are often blamed (by
professionals) for interfering with or
negating the effects of their treatment
(Moffatt, 2004). As clinicians, we
need to be aware of and consider the
factors that lead to non-concordance
when faced with a patient who finds it
difficult to tolerate compression.
We should not be hasty to attach
the non-concordant label (few patients
are truly non-concordant), but rather,
question if we have done our upmost
to find the right solution for the
David Gray, Professor of Tissue
Viability, Tissue Viability Practice
Development Unit, Birmingham
City University, and Clinical Nurse
Specialist Tissue Viability, NHS
Grampian, Aberdeen
Achieving compression
therapy concordance
in the new NHS: a
challenge for clinicians
‘Patients that have difficulty
with compression therapy
are often blamed (by
professionals) for interfering
with or negating the effects of
their treatment.’
The benefits of using compression
therapy for the management and
prevention of recurrence of leg ulcers
and the management of chronic
oedema are well documented.
Current guidelines promote a
two-step approach to compression
therapy; intensive treatment using
a bandaging system to promote
healing and gain control of
symptoms such as excess exudate
and swelling, then hosiery as
maintenance treatment for patients
once the ulcer has healed and/
or oedema reduced (International
Lymphoedema Framework, 2006;
Royal College of Nursing [RCN],
2006; Scottish Intercollegiate
Guidelines Network [SIGN]; 2010].
The cost of leg ulcer management
to the NHS in terms of dressings
and other materials, medical and
nursing time, and hospital resources is
mostly borne in primary care and the
community nursing services, and is
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