This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Scottish leg ulcer project: a randomized trial evaluating the implementation of national guidelines. BJS 2001; 88: 607-608.
Published: 6th December 2002
Authors: C. V. Ruckley
Background
Innumerable consensus documents and guidelines have been published, but little is known about their implementation or impact. Community nurses provide more than 80 per cent of the care of patients with chronic leg ulcers. Healing rates of 50–74 per cent at 3 months have been reported in published trials. Outcomes in the community are largely unknown. National guidelines on leg ulcer care were published in 1998 by the Scottish Intercollegiate Guideline Network (SIGN), which produces evidence‐based guidelines using strict criteria and methodology. The aim was to evaluate the impact of national guidelines, with or without a structured nurse training programme, on leg ulcer healing rates in the community nationwide.
Method
Community healthcare trusts covering a population of 2·65 million were divided into 50 geographically and administratively distinct localities averaging 53 000 population, which were randomized to either SIGN guidelines (control) or guidelines plus a guideline‐based nurse training programme (intervention). Data were collected from 649 caseload managers by 3‐monthly censuses throughout the 2·5 years of the project. After a 6‐month baseline period, guidelines were distributed and an intensive programme of training was provided throughout Scotland by a multidisciplinary team in the intervention localities for 51 link nurses, who were trained and resourced to cascade their training to approximately 1700 community nurses.
Results
Some 4413 patients with 4984 ulcerated legs were registered. The mean age of 77 years was more than a decade older than that in published trials. Multiple co‐morbidities were reported. The response rate from caseload managers was 99·4 per cent, rising to 100 per cent for the rest of the study. Intercensal follow‐up was complete for 98·9 per cent of patients. The baseline 3‐month ulcer healing rate was 30 per cent; it remained the same throughout the subsequent 2 years, with no difference between intervention and control groups.
Conclusion
Neither national guidelines nor an intensive training programme made any impact on leg ulcer healing rates. The outcomes of leg ulcer care are poor. The delivery of care requires reorganization. The impact and implementation of consensus statements and guidelines should be evaluated. © 2001 British Journal of Surgery Society Ltd
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