Antibiotic prescription using a digital decision support system: a register-based study of patients with hard-to-heal ulcers in Sweden

Wickström, Hanna; Fagerström, Cecilia; Öien, Rut; Anderberg, Peter; Midlöv, Patrik

doi:10.1136/bmjopen-2021-060683

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…All ulcer types, that do not, or are not expected to heal within six weeks, are registered in the registry [15] of which venous ulcers are the most common etiology/diagnosis. In the registry, nurses, assistant nurses, and/or physicians report ulcers in a standardized and verified procedure [14]. Two registrations take place in RUT, at the first contact with the healthcare staff, when the diagnosis is set, and when the ulcer is healed (or when treatment is discontinued for some other reason) [45].…”

Section: Swedish National Registry Of Ulcer Treatmentmentioning

confidence: 99%

“…Since VLUs commonly take time to heal, they have been referred to as chronic [11]. Later research rather discusses hard-to-heal ulcers [12][13][14], a description that is used by the Swedish National Registry for Ulcer Treatment (RUT) [15]. Regardless of whether VLUs are considered chronic or hard-to-heal, the risk factors and underlying causes of the ulcer bring a chronic increased risk for recurrence of new ulcers connected to new health care visits.…”

Section: Introductionmentioning

confidence: 99%

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Associations between self-care advice and healing time in patients with venous leg ulcer– a Swedish registry-based study

Rosenburg,

Tuvesson,

Lindqvist

et al. 2024

BMC Geriatr

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Background Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient’s nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff’s advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors. Methods The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time. Results No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32–2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12–2.15, p = 0.009) showed an association with longer healing time. Conclusions Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.

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Section: Swedish National Registry Of Ulcer Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Associations between self-care advice and healing time in patients with venous leg ulcer– a Swedish registry-based study

Rosenburg,

Tuvesson,

Lindqvist

et al. 2024

BMC Geriatr

Self Cite

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“…Given that different units (e.g., levels of care) use the registry, I would argue that there is a certain level of generalizability to the Swedish population. Generally, data from Swedish national quality registries are generalizable (Johansson et al, 2021;Wickström et al, 2018;Wickström et al, 2022). As regards international generalizability, the structure of care should be taken into consideration.…”

Section: Study IIImentioning

confidence: 99%

“…Nevertheless, data from national quality registries are considered important due to the size of the material, and the long period of collection, which could be decades for some patients (Centre of Registers Västra Götaland, n.d.). However, registrars are not obliged to perform registrations after healing, even though reminders are sent (Wickström et al, 2022), which might have led to some healed ulcers missing from the register. Registrars are healthcare professionals, trained in using the RUT in accordance with a pre-defined protocol (Hellström et al, 2016).…”

Section: Study IIImentioning

confidence: 99%

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Living with a venous leg ulcer: Lived experiences and the presence of self-care in daily life

Rosenburg

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[en] Aim: The overall aim of this thesis was to describe the lived experiences of patients with hard-to-heal venous leg ulcers before and after healing, as well as the understanding of the role and presence of self-care activities in ulcer management. Methods: The thesis is based on four studies, with differing designs. In Studies I and II, a phenomenological approach was used. To describe lived experiences of undergoing ulcer management, 16 persons were interviewed (I), and to describe lived experiences of daily life after healing,15 persons were interviewed (II). Study III was a registry-based, quantitative study. In total, data from 699 patients with venous leg ulcers(VLUs) were analyzed. Logistic regressions were performed to describe associations between advice given on self-care and its impact on ulcer healing. Study IV, which focused on patient experiences of the feasibility of an intervention for self-care, was based on eleven interviews with six patients with VLUs. The data from the interviews underwent qualitative content analysis. Results: Ulcer management aims at ulcer healing. In the protracted process, patients often experience hopelessness. When healing is slow, patients doubt the professionals’ knowledge. A patient’s trust in professionals and the entire healthcare system may erode if treatment and information vary between different professionals (Study I). Study II revealed that daily life after healing was still strongly affected by the ulcer. Memories from a lost period in life were ever-present. Life after healing was changed – for some, life was not very eventful. The patients’ own knowledge was often limited, and there was a struggle to do what was best for the own body to prevent a new ulcer. Study III revealed that advice on nutrition and physical activity had no impact on healing time. Only 44% of the sample were advised on both nutrition and physical activity. It was common to have an ulcer for a long time before seeking help; about half of the sample had an ulcer for >84 days before registration. Other findings were that the median age among the 699 patients was 77 years, the majority were female, and comorbidity was common. The intervention tested in Study IV offered welcomed information. However, even among those experiencing some sense of recognition, the link to their own situation and life was unclear. The technical solution with videos on a flash drive was difficult for most people to use. The importance of close cooperation with professionals was highlighted. Conclusion: Venous leg ulcers have a profound impact on patients and their life situations. Ulcer management can, in different ways, impose suffering on patients. Not being listened to or seen as a person is anexperience that leaves its marks on a patient. When healing is slow, and someone has to be blamed, relationships with professionals are damaged. The role of self-care is unclear for most patients, which makes self-care harder. Those who tried a video-based intervention for self-care showed difficulties in relating it to their own life. Enabling a caring relationship can enhance patients’ understanding of information and advice. Patients must be invited to share their own experiences, to create a foundation for self-care. The provision of advice alone is not the solution to the issues related to self-care.

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Management and outcomes among patients with hard-to-heal ulcers in Sweden: a national mapping of data from medical records, focusing on diagnoses, ulcer healing, ulcer treatment time, pain and prescription of analgesics and antibiotics

Öien,

Roxenius,

Boström

et al. 2024

BMJ Open

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ObjectiveTo investigate whether patients with hard-to-heal ulcers in Sweden were treated according to an aetiological diagnosis and to explore ulcer healing, treatment time, ulcer-related pain and the prescription of analgesics and antibiotics.DesignA national mapping of data from the patients’ medical records, between April 2021 and March 2023.SettingData from medical records for patients with hard-to-heal ulcers from a randomised clustered sample of two units per level of care and region.ParticipantsPatients with hard-to-heal ulcers treated in primary, community and specialist care, public or private, within units covering all 21 regions in Sweden.Outcome measuresDescriptive analysis of data from the patients’ medical records.ResultsA total of 2470 patients from 168 units were included, of which 39% were treated in primary care, 24% in community care and 37% in specialist care. A total of 49% of patients were treated without an aetiological diagnosis. Healing occurred in 37% of patients and ulcer-related pain was experienced by 1224 patients (50%). Antibiotics were given to 56% of the patients. Amputation occurred in 5% and 11% were deceased.ConclusionOnly 51% of patients with hard-to-heal ulcers had a documented aetiological ulcer diagnosis, which means that approximately 20 000 patients in Sweden might receive suboptimal treatment. Future research needs to explore why so many patients are undiagnosed and how to improve diagnosis, which could lead to faster healing and shorter treatment times.

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Antibiotic prescription using a digital decision support system: a register-based study of patients with hard-to-heal ulcers in Sweden

Cited by 4 publications

References 31 publications

Associations between self-care advice and healing time in patients with venous leg ulcer– a Swedish registry-based study

Associations between self-care advice and healing time in patients with venous leg ulcer– a Swedish registry-based study

Living with a venous leg ulcer: Lived experiences and the presence of self-care in daily life

Management and outcomes among patients with hard-to-heal ulcers in Sweden: a national mapping of data from medical records, focusing on diagnoses, ulcer healing, ulcer treatment time, pain and prescription of analgesics and antibiotics

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