Referrals to secondary care for management of chronic leg oedema are high and there is a low rate of detection of oedema in primary care that could be treated with compression hosiery to prevent complications. Non-adherence to compression hosiery is common, leading to poorer outcomes of therapy, more risk of problems, and increased waste. We aimed to develop a model of care to improve the management of patients with early signs of oedema as a precursor to venous disease or lymphoedema in primary care through a supported assessment and review process.
A Trust-employed Chronic Oedema Liaison (COL) therapist was employed to perform a range of functions to enable GP practices to provide Healthy Leg Clinics1. These included identification of patients with simple oedema, setting up coding and recall systems, triaging of chronic oedema conditions, and developing a Chronic Oedema Pathway for GP referrals. The COL therapist rotated between GP Practices recruited in a Local Commissioning Group (LCG) area. A practice nurse/ pharmacist, initially educated by the COL therapist, assessed and reviewed patients currently in compression hosiery in the longer term. Local GPs and community pharmacists were educated through group education sessions to ensure a successful outcome.
We found that In 150 patients who attended healthy leg clinics in 12 GP practices, 41 prescribing changes were made to optimise compression hosiery. In 31% of patients prescribed diuretics, they were de-prescribed. Targeted education for practice staff identified 101 patients with a new diagnosis of simple oedema. Working in collaboration with practice managers, recall systems were developed to assist with yearly review. Delivery of practical advice to community pharmacists in each area regarding limb measurement and donning aids for compression hosiery complimented the service and reduced GP workload, whilst ensuring the patient received the appropriate sized garment.
A seamless service was delivered to the patient, through education and follow up, resulting in improved quality of life reported through patient feedback. Implementation of the Chronic Oedema Pathway for GPs and development of the healthy legs service resulted in prompt and timely preventative compression hosiery therapy, improved cost-effective management and reduced inappropriate prescribing in patients with simple oedema.
