Clinical evaluation with long-Term follow-up of patients with pressure ulcers in one Swedish county

Objective: To conduct a screening, skin examination and risk assessment of patients with pressure ulcers (PUs) in one Swedish county (inpatient, primary and community care) with follow-up after six months to investigate ulcer healing, frequency of amputation and mortality rate linked to preventive measures. Method: The methodology recommended by the European Pressure Ulcer Advisory Panel was used. Screening, risk assessment and skin examination were performed during March 2017. The modified Norton scale was used to assess PU risk, with a score of ≤20 indicating presence of risk. A research questionnaire was used to document prevention and treatment. Follow-up was performed after six months, during September 2017. The same research questionnaire was used to capture the current situation of the patients, including ulcer healing, frequency of amputation, and mortality rate. Results: Screening covered 464 patients: 303 hospitalised, 68 in community care, and 93 in primary care. A total of 110 patients 55 at risk of PU and 55 with PUs, the majority of which were category 2-4 PUs were included in the study. At follow-up, 67% were treated in community care, 32% in primary care, and 1% in hospital. Mortality rate for patients with PUs was 44%. Of the remaining 31 patients, 17 had unhealed PUs, 10 had healed PUs, two had undergone amputation, and complete follow-up data was missing in the remaining two patients. Conclusion: These results reflect the complex situation of an aged and frail patient group, including a lack of preventive measures and follow-up routines in community and primary care. Declaration of interest: The authors have no conflict of interest to declare with regard to this work

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

OBJECTIVES: To investigate differences in antibiotic prescription for patients with hard-to-heal ulcers assessed using a digital decision support system (DDSS) compared with those assessed without using a DDSS. A further aim was to examine predictors for antibiotic prescription.DESIGN: Register-based study.SETTING: In 2018-2019, healthcare staff in primary, community and specialist care in Sweden tested a DDSS that offers a mobile application for data and photograph transfer to a platform for multidisciplinary consultation and automatic transmission of data to the Registry of Ulcer Treatment (RUT). Register-based data from patients assessed and diagnosed using the DDSS combined with the RUT was compared with register-based data from patients whose assessments were merely registered in the RUT.PARTICIPANTS: A total of 117 patients assessed using the DDSS combined with the RUT (the study group) were compared with 1784 patients whose assessments were registered in the RUT without using the DDSS (the control group).PRIMARY AND SECONDARY OUTCOME MEASURES: The differences in antibiotic prescription were analysed using the Pearson's χ 2 test. A logistic regression analysis was used to check for influencing factors on antibiotic prescription. RESULTS: Patients assessed using a DDSS in combination with the RUT had significantly lower antibiotic prescription than patients entered in the RUT without using the DDSS (8% vs 26%) (p=0.002) (only healed ulcers included). Predictors for antibiotic prescription were diabetes; long healing time; having an arterial, neuropathic or malignant ulcer.CONCLUSIONS: A DDSS with data and photograph transfer that enables multidisciplinary communication appears to be a suitable tool to reduce antibiotic prescription for patients with hard-to-heal ulcers

Comparing video consultation with inperson assessment for Swedish patients with hard-to-heal ulcers : registry-based studies of healing time and of waiting time

Objectives To investigate differences in ulcer healing time and waiting time between video consultation and inperson assessment for patients with hard-to-heal ulcers. Setting Patients treated at Blekinge Wound Healing Centre, a primary care centre covering the whole of Blekinge county (150 000 inhabitants), were compared with patients registered and treated according to the Registry of Ulcer Treatment, a Swedish national web-based quality registry. Participants In the study for analysing ulcer healing time, the study group consisted of 100 patients diagnosed through video consultation between October 2014 and September 2016. The control group for analysing healing time consisted of 1888 patients diagnosed through inperson assessment during the same period. In the study for analysing waiting time, the same study group (n=100) was compared with 100 patients diagnosed through inperson assessment. Primary and secondary outcome measures Differences in ulcer healing time were analysed using the log-rank test. Differences in waiting time were analysed using the Mann-Whitney U test. Results Median healing time was 59 days (95% CI 40 to 78) in the study group and 82 days (95% CI 75 to 89) in the control group (P&lt;0.001). Median waiting time was 25 days (range: 1-83 days) in the study group and 32 days (range: 3-294 days) for patients diagnosed through inperson assessment (P=0.017). There were no significant differences between the study group and the control group regarding age, gender or ulcer size. Conclusions Healing time and waiting time were significantly shorter for patients diagnosed through video consultation compared with those diagnosed through inperson assessment.CC BY-NC 4.0</p