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

Harrison, Margaret B.; Graham, Ian D.; Lorimer, Karen; VanDenKerkhof, Elizabeth G.; Buchanan, Maureen; Wells, Phil; Brandys, Tim; Pierscianowski, Tadeusz A.

doi:10.1186/1472-6963-8-243

Cited by 46 publications

(64 citation statements)

References 30 publications

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“…For example, to streamline the process of assessment and facilitate application of evidence-based care, documentation forms were created to collect information about the cause of the ulcer, with venous symptoms and history on one side of the page and arterial symptoms on the other. With the exception of a few studies such as this collaboration for care of ulcers of the leg, 10,13,17 no validated process for the adaptation of guidelines has been documented. Recently, the Canadian work 16 in this area was integrated with an international initiative known as the ADAPTE collaboration (www.adapte.org).…”

Section: How Are Guidelines Adapted For Local Use?mentioning

confidence: 99%

“…10,13 Regional managers of home care were concerned about costs of supplies, amount of nursing time, and frequency of visiting for clients with ulcers of the leg. A regional task force was developed to review existing practice guidelines to help guide the care plan.…”

Section: Why Adapt Guidelines For Local Use?mentioning

confidence: 99%

“…The process engages end-users in the guideline adaptation process to address specific health-related questions relevant to its context of use. The goal is to establish a standard of being transparent, • Use of reliable and consistent methods to ensure the quality of the adapted guideline, 9,19 • Participation of key stakeholders to foster acceptance and ownership of the adapted guideline and ultimately promote its use, 13,14 • Consideration of context during adaptation to ensure relevance for local practice and policy, 13,21 • Transparent reporting to promote confidence in the recommendations of the adapted guideline, 9,20 • Use of a flexible format to accommodate specific needs and circumstances, 18,22 and • Respect for and acknowledgement of guideline materials used as sources. …”

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confidence: 99%

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Adapting clinical practice guidelines to local context and assessing barriers to their use

Harrison¹,

Légaré²,

Graham³

et al. 2009

Canadian Medical Association Journal

312

322

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Key points• Clinical practice guidelines can be adapted to local circumstances and settings to avoid duplication of efforts and optimize use of resources.• The ADAPTE process is an approach to adapting guidelines to local contexts through the explicit participation of relevant decision-makers.• Assessing barriers to and facilitators of the use of knowledge is closely linked to the adaptation and uptake of the evidence. Review CMAJ • FEBRUARY 9, 2010 • 182(2) E79evidence-based practice guidelines have become mandatory for the care of patients with cancer in France. 14 For many regions and territorial jurisdictions, de novo development of guidelines is not feasible because of lack of time, expertise and resources, and thus taking advantage of existing highquality guidelines is sensible. [15][16][17] Adaptation of existing high-quality guidelines for local use is an approach with the potential to reduce duplication of effort and enhance applicability. National guidelines often lack details on applicability and description of the changes in the organization of care required to apply the recommendations. 18 Adaptation of evidence may promote local uptake of evidence through a sense of ownership by the end-users who are engaged in this process. However, customizing a guideline to local conditions could weaken the integrity of the evidence base. We outline a systematic, participatory approach for evaluating and adapting available guidelines to a local context of use while maintaining the quality and validity of the guideline. Whether evidence is provided in the format of syntheses of knowledge, patient decision aids or clinical practice guidelines, end-users must consider if or how it could be adapted to the local context and the same principles can be applied to ensure these factors are considered before implementation of the evidence.To illustrate how to adapt guidelines, we will use a recent study that was performed to improve community care of individuals living with venous ulcers of the leg. 10,13 Regional managers of home care were concerned about costs of supplies, amount of nursing time, and frequency of visiting for clients with ulcers of the leg. A regional task force was developed to review existing practice guidelines to help guide the care plan. The task force identified that many of these guidelines were from international bodies and would require adaptation to the local context. How are guidelines adapted for local use?Existing guidelines can be evaluated and customized to fit local circumstances through an active, systematic and participatory process. This process must preserve the integrity of the evidence-based recommendations when differences in organizational, regional or cultural circumstances may legitimately require important variations in recommendations. 8,9,[14][15][16]19 In adapting a guideline, consideration is given to local evidence, such as specific health questions relevant to a local context of use; to specific needs, priorities, legislation, policies and resources; to scopes of practic...

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Section: How Are Guidelines Adapted For Local Use?mentioning

confidence: 99%

Section: Why Adapt Guidelines For Local Use?mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Adapting clinical practice guidelines to local context and assessing barriers to their use

Harrison¹,

Légaré²,

Graham³

et al. 2009

Canadian Medical Association Journal

312

322

View full text Add to dashboard Cite

show abstract

“…1 Usually they are not seen as a pressing public health problem, although representing a common, complex and costly condition 2 , since interfere with several of the individual life of the components, such as mobility, sleep and rest, and cause stress, anxiety, severe pain and persistent in many cases. [1][2] They are of multifactorial etiology, such as venous disease, arterial, diabetic neuropathy, cancer, and metabolic, hematologic and infectious and parasitic diseases.…”

mentioning

confidence: 99%

Prevalence of venous ulcers and associated factors among adults of a health center in Vitória da Conquista – BA

Oliveira¹,

Soares

Pires

2015

R. pesq. cuid. fundam. online

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Objetivo:Estimar a prevalência de úlceras venosas e identificar os fatores sociodemográficos, comportamentais, de saúde, características da ferida e tratamento associados entre indivíduos adultos atendidos em um Centro de Saúde de Vitória da Conquista – BA. Métodos: Trata-se de um estudo transversal no qual foram estudados 42 indivíduos. As análises estatísticas foram feitas no Epi Info versão 3.5.3. Resultados: A prevalência de úlceras venosas foi de 83,3%, sendo maior no sexo feminino (95,5%). Os fatores que se mantiveram associados foram o sexo, morar acompanhado, diabetes, insuficiência venosa crônica, presença de dor, tempo de inicio da primeira úlcera e reincidência da ferida. Conclusão: Os resultados sugerem a necessidade de novas pesquisas para melhorar os registros nacionais acerca das úlceras venosas e viabilizar estratégias que garantam uma melhor assistência a saúde baseada em evidências científicas e clínicas.

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“…In a number of countries (Canada [2], the UK [3], Sweden [4], and Australia [29]) healing rates of VLUs improved and the cost of care declined after the implementation of an evidence-based service. Importantly, it was the organisation of care and not the setting where such care was delivered (in the patient's home or in a community nurse-led clinic) that influenced healing rates [43]. It is possible that the above-mentioned socioeconomic variables (low social class, being single, or lack of central heating) associated with delayed healing were rather a reflection of inadequate wound care provided by the healthcare system.…”

Section: Factors Related To the Organisation Of Wound Carementioning

confidence: 99%

Prognostic factors for delayed healing of venous leg ulcers

Simka¹

2014

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Risk factors of poor healing of venous leg ulcers can be categorised into three main groups: those related to the ulcer, those related to the patient, and those related to the organisation of wound care. Identification of risk factors that predispose these patients to prolonged wound healing not only offers an opportunity to determine their clinical outcome, but can also be linked to the decision regarding alternative interventions or even reorganisation of the wound care. Factors related to the ulcer comprise large ulcer size and long ulcer duration. Also, some macroscopic features of venous leg ulcers are associated with delayed healing: fibrin covering more than 50% of the area of the wound and highly exuding ulcers. Coexisting non-venous vascular pathologies, such as arterial ischaemia or clinically relevant lymphedema, as well as history of deep vein thrombosis, can contribute to delayed healing. Additionally, pathological functioning of calf muscle pump can be associated with reduced healing. Some bacterium species seem to interfere with healing of venous leg ulcers, especially if the number of such microorganisms in the wound bed is high. Regarding patient characteristics, reduced mobility (patients being chair or bedbound) is a risk factor, while it remains unclear whether the demographic characteristics of the patients or their non-vascular co-morbidities are really associated with impaired healing. In addition, a number of studies have shown that organisation of wound care of venous leg ulcer patients appeared to be important, and healing rates improved and the cost of care declined after the implementation of an evidence-based service.

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

Cited by 46 publications

References 30 publications

Adapting clinical practice guidelines to local context and assessing barriers to their use

Adapting clinical practice guidelines to local context and assessing barriers to their use

Prevalence of venous ulcers and associated factors among adults of a health center in Vitória da Conquista – BA

Prognostic factors for delayed healing of venous leg ulcers

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