Community leg ulcer clinics: a comparative study in two health authorities

Abstract Objective : To compare the outcome and cost of care for leg ulcers in community leg ulcer clinics in Stockport District Health Authority with Trafford District Health Authority as a control. Design : Detailed cost and efficacy studies conducted prospectively over a three month period in both districts both before and one year after the introduction of five leg ulcer clinics in Stockport. Setting : Two large district health authorities of broad socioeconomic mix and total population of 540 000. Patients : All patients receiving treatment for an active leg ulcer, irrespective of the profession or location of their carer. Main outcome measures : The proportion of ulcerated limbs completely healed within three months and total cost of leg ulcer care. Results : The introduction of community clinics in Stockport improved healing of leg ulcers from 66/252 (26%) in 1993 to 99/233 (42%) in 1994 (P<0.001) compared with in Trafford, where 47/203 (23%) healed in 1993 and only 43/213 (20%) in 1994. This improved result in Stockport was achieved while the annual expenditure on care of leg ulcers was reduced from £409 991 to only £253 371. In the same year the cost of leg ulcer care in Trafford increased from £556 039 to £673 318. Conclusion : In the first year after the introduction of community clinics, before most patients in Stockport had access to these clinics, healing of leg ulcers was already improved whereas costs were reduced. Key messages The introduction of community leg ulcer clinics improved care and resulted in lower costs than the traditional approach that the clinics replaced Planned and coordinated programmes of care can reduce costs substantially while improving healing rates Community units and general practitioners should be encouraged to seek alternatives to the standard care for leg ulcers