Adjunctive Therapies and Organizational Support
Adjunctive therapies are to be used in combination with best practices for patients with healable venous leg ulcers where the cause is known and can be corrected. Some modalities to be aware of are therapeutic ultrasound, electrical stimulation and electromagnetic therapy (Team et al., 2019). Neuromuscular electrical stimulation (NMES) has been shown to improve circulation, reduce edema, and improve wound healing outcomes.
Organizational and system support according to the Best Practice Recommendations for the Prevention and Management of Venous Leg Ulcers (Evans et al., 2019) states that “decision-makers, and those who oversee financial budgets recognize the importance of providing evidence-informed, cost-effective care for the prevention and management of venous leg ulcers.”
There is often limited budgets and resources, challenging clinicians to provide appropriate care. It is imperative that healthcare systems allow resources for care providers to deliver venous ulcer care within their designated scope of practice. As well, decision-makers on a macro level (administrators, managers, local and regional governments) must assess the value of best practices and continued education for team members as these translate to improved, cost-effective patient outcomes.
Venous disease organizational issues that need to be considered include:
- Adequate funding for compression garments or the newer self-adjustable hook and- loop fastener systems. This would be a consideration for primary and secondary prevention optimizing the management of venous ulcers.
- The role of self-management for venous disease through education and access to compression garments including hook-and-loop fastener systems
- Funding for physiotherapy assessment and treatment programs to improve calf-muscle pump function
- Funding for footwear that accommodate lower-limb devices and garments (compression)
Dr. Robyn Evans is currently the Medical Director of the Wound Healing Clinic at Women’s College Hospital, involved in research and teaching. She also is a full-time family physician in the community. She is part of the faculty of the International Interprofessional Wound Course through the University of Toronto. She is medical lead for Wounds Canada to support the development of inter-professional education programs for clinicians as well as delivery and evaluation of these programs.
Cathy Burrows developed and coordinated the Leg Ulcer Clinic- QEII Health Sciences Centre, Halifax, NS- 1999-2012.Past President CAWC-2007-2009.Recipient of Excellence in Nursing award- College of Registered Nurses of NS- 2007. Masters in Wound Care, University of Toronto- 2008.Clinical Advisor- Wound Care Canada- 2011-to date. Currently a clinical/educational consultant with Perfuse Medtec Inc.