Community-based treatment for chronic edema: an effective service model

Moffatt, C. J., Doherty, D. C., Franks, P. J. and Mortimer, P. S. (2018) Community-based treatment for chronic edema: an effective service model. Lymphatic Research and Biology, 16(1), pp. 92-99. (doi: 10.1089/lrb.2017.0021) (PMID:29432067)

Abstract

Background: Chronic edema care is patchy and of variable quality internationally. This study was undertaken to develop and evaluate a system of care that would provide for patients within a geographical area of London (Wandsworth), United Kingdom. Methods and Results: A prospective cohort design with intervention of a new service design following a 6-month baseline period. Patients were identified through health professionals. A stratified random sample was drawn from all patients and an implementation strategy developed. Clinical assessment combined with questionnaires evaluated clinical, patient, and health service outcomes at 6-month periods. In all, 312 patients were identified in community and acute services giving a crude ascertainment rate of 1.16 per 1000 population. The random sample of 107 was mostly female (82%) with mean (standard deviation) age of 72.9 (12.4) in men and 68.6 (15.0) years in women. Mean reductions in limb volume achieved statistical differences at 6–12 months after implementation (difference [d] = 115 mL, p = 0.0001). Incidence of cellulitis dropped from 41.5/100 patient years at baseline to zero at 6–12 months. Quality of life showed greatest improvements between baseline and 6 months postimplementation, the largest differences being in role physical (d = 32.7, p = 0.0001) and role emotion (d = 24.0, p < 0.0001). EuroQol increased following implementation by a mean score of 0.05 (p = 0.007). There was a reduction in 6 monthly healthcare costs from £50171 per 100 patients at baseline to £17618 between 6 and 12 months. Conclusions: This process of implementation improves health outcomes while reducing healthcare costs in patients with lymphedema.

• Item Type: Articles
• Additional Information: This work was supported by the King's Fund.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Franks, Professor Peter
• Authors: Moffatt, C. J., Doherty, D. C., Franks, P. J., and Mortimer, P. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Lymphatic Research and Biology
• Publisher: Mary Ann Liebert
• ISSN: 1539-6851
• ISSN (Online): 1557-8585