Quality-of-care for leg ulcers in the metropolitan area of Hamburg - a community-based study
Quality-of-care for leg ulcers in the metropolitan area of Hamburg - a community-based study
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DOI：
10.1111/j.1468-3083.2011.04110.x
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发表时间：
2012-04-01
影响因子：
9.2
通讯作者：
Augustin, M.
中科院分区：
文献类型：
--
作者：
Herberger, K.;Rustenbach, S. J.;Augustin, M.
背景：慢性伤口的诊断和治疗是一个跨学科的挑战，应该以指导标准为导向。虽然没有关于德国护理质量的数据，但可以从定性估计和专家报告中得出结论，大多数患者没有得到适当的治疗。目的利用新开发的基于指南的指标评价汉堡市区腿部溃疡的护理质量。方法对不同病因的下肢溃疡患者进行连续分析。220个保健提供者的范围包括伤口诊所、办公室诊所、疗养院、家庭护理服务和养老院。调查内容包括临床检查和填写关于生活质量、治疗经历和保健质量的问卷。结果共纳入520例下肢溃疡患者。在这些患者中，63%为静脉源性，23%为混合性，2%为血管源性，12%为其他来源；78.6%的患者采用湿性创面敷料治疗。疼痛治疗占54.1%，压迫治疗占53.5%。缺点被指出在诊断检查和伴随的伤口护理，如物理治疗。大约70%的人在生活质量上表现出明显或严重的损害。护理质量指数显示，实际护理满足64%的指标；61.8%的患者表现出足够的护理质量，无论年龄、社会地位、居住地或保险状况如何。结论虽然大多数患者得到了充分的治疗，但许多患者没有按照指南得到适当的治疗。
Background Diagnosis and therapy of chronic wounds constitute an interdisciplinary challenge and should be oriented on the guideline standards. Although no data on the quality-of-care are available for Germany, it can be concluded from qualitative estimates and expert reports that the majority of patients are not receiving adequate treatment.Objectives Evaluation of the quality-of-care for leg ulcers in the metropolitan area of Hamburg by means of newly developed guideline-based indicators.Methods Leg ulcer patients of any aetiology were consecutively included. The spectrum of 220 health-care providers ranged from wound clinics, office-based practices, nursing homes to home-care services and doss houses. The survey included a clinical examination and the completion of questionnaires covering quality of life, experiences with treatment and quality of health care.Results A total of 520 patients with leg ulcers were included. Among these patients, 63% were of venous, 23% of mixed, 2% of vasculitic and 12% of other origin; 78.6% of the patients were treated with moist wound dressings. Pain therapy was performed in 54.1%, compression therapy in 53.5%. Shortcomings were noted in the diagnostic work-up and in concomitant wound care such as physiotherapy. Around 70% displayed marked to profound impairment in quality of life. The quality-of-care index showed that 64% of the indicators were met by the actual care; 61.8% of the patients exhibiting a sufficient quality-of-care, regardless of age, social status, place of abode or insurance status.Conclusions Although the majority of patients received adequate therapy, many patients are not being treated properly in accordance with the guidelines.