Abstract No. 295 A Retrospective Analysis of Guideline-Based Care of Venous Leg Ulcers in a Rural Healthcare System

Access to specialty care is often limited in rural settings. Therefore, rural primary care clinicians may be the first and only providers to diagnose and treat venous leg ulcer (VLU). Studies have identified several barriers that can reduce primary care clinician adherence to clinical practice guidelines (CPGs). The 2014 CPG for management of VLUs recommends performing a venous reflux duplex ultrasound (VRDUS) and prescribing pentoxifylline. The purpose of this study is to determine if specialty-trained vascular and wound care clinicians in a large rural healthcare system are more likely than other clinicians to adhere to the 2014 CPG for VLUs. A retrospective review of the electronic medical record was conducted. ICD-10 and ICD-9 codes related to VLUs were used to identify patients with a new VLU diagnosis between January 1, 2011, and January 1, 2021. VRDUS studies performed anytime from 1 year before the date of VLU diagnosis to 1 year after the date of diagnosis were identified. Specialty care appointments including VLUs among their primary diagnoses were also identified, as was the presence or absence of pentoxifylline on the medication list. Demographic and medical history data were collected for 2061 patients. Mean age is 70±14 years. Males and females are equally represented. Racial and ethnic makeup is typical of the geographic region. VRDUS (16%, 322/2061) and pentoxifylline (0.7%, 15/2061) are infrequently prescribed. Evaluation by a vascular specialist significantly increases the frequency of undergoing VRDUS from 5% (65/1376) to 38% (257/685) (OR=12, 95% CI: [8.91, 16.4]). Seeing a wound care specialist increases the frequency of being prescribed pentoxifylline from 0.7% (4/1302) to 1.4% (11/759) (OR=3.49, 95% CI: [1.13,13.1]). Being prescribed pentoxifylline increases the likelihood of undergoing VRDUS (0.2% vs 3.4%, OR 15.8, 95% CI: [5.13,59.5]). Increased referrals to specialists and/or referring clinician education on guideline-based care may be of benefit to patients with VLUs. Major study limitations include only identifying appointments for which VLU was listed as a primary diagnosis, and the lack of clinical outcomes to determine if differences in VRDUS and pentoxifylline rates are associated with differences in ulcer outcomes. Further study is needed to confirm these findings and determine if they are generalizable.