Treating leg ulcers at home as effective as in the clinic, Queen’s-led study shows

Kingston - A new Queen’s University study shows that the organization of care, rather than the setting in which it’s delivered, is the crucial factor in treating patients with painful leg ulcers.

This finding contradicts earlier studies that promoted treatment of the debilitating condition in clinics, rather than the patient’s home. Leg ulcers are open sores that develop below the knee, usually due to poor blood circulation, and occur most commonly in older people.

“Other reports on this subject, from the UK, conclude that clinic care is superior to home care,” says Nursing professor Margaret Harrison, who led the Queen’s study. “Our research from Ontario shows that the setting of the care is not as important as how it’s organized. This gives Community Care Access Centres (CCACs), the local organizations that provide these health services, a viable option about where to deliver care. It may also provide choice for individuals who are not house-bound.”

The study was conducted with 126 individuals across southeastern Ontario. People who were considered mobile either received care for their leg ulcers in their homes or went to nurse-run clinics. Data was collected every three months until healing occurred, and included a one-year follow-up to track the durability of healing.

“Leg ulcers are serious wounds, but people who suffer from them are a forgotten group. As our population ages, we’re seeing a rise in the number of leg ulcers and we need to be doing more to help these people,” adds Dr. Harrison. “Plus, the organization of care needs to include implementation of best practice guideline recommendations and a delivery system that supports this. With leg ulcer care, there is gold standard evidence for what should be done requiring specially trained nurses, some additional equipment and regular assessments.”

Some of the patients in the trial had had leg ulcers for decades. If not properly treated, these painful, weeping sores can grow to envelop the entire leg and affect the sufferers’ entire quality of life.

People had a variety of reasons for choosing their care setting, adds Dr. Harrison. Some were simply more comfortable in their own homes, some patients looked after spouses who were house-bound, and some didn’t have a readily accessible clinic in their community. “Wherever they received their care, however, when the care was organized properly, it was effective,” she says.

Part of a multi-year initiative, the next study will determine the effect on healing when people choose their preferred care location. Funding for the trial was provided by the Canadian Institutes of Health Research.