A relational database within the Leg Club Network: an audit.

The growing prevalence of venous leg ulcers in an ageing population presents challenges for wound care and management. The Lindsay Leg Club model is an alternative approach to the management of leg health that can improve patient outcomes. This article reports on an audit of a relational database located within the Leg Club Network, containing records of more than 17 000 patients (known as members) who attended a Leg Club in a 5-year period (2014-2019). Overall, over 266 000 member leg assessments and treatments were entered into the database. The average nurse-member attendance time was 28 min, with a skill mix of 23% senior nurses, 70% qualified and associate nurses, and 7% nurses in supervisory roles. Healing rates averaged 62% after 12 weeks. Recurrence rates were 20% after 12 weeks. Annual clinical and volunteer hours averaged 821 and 800 h, respectively. Staffing costs were £28 per wound treatment or leg assessment with a typical duration of 27 min; 71% of members were aged 70 to 94 years old, which indicates the need for a service that caters to the specific requirements of this age group. However, no data on psychosocial and well-being outcomes were recorded. Their inclusion in further developments of this database is recommended.

Patient empowerment: a general practice perspective.

Patient empowerment is a frequently promoted aim for patients but is rarely put in to clinical practice. This paper describes the basic principles behind a club enabling treatment and prevention of leg ulceration in the community. These principles include patient ownership of the club, community involvement and a non-medical environment. The practical issues involved in setting up a Leg Club(R) are described in detail including engagement of healthcare professionals, community volunteers and appropriate transport.

Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial.

OBJECTIVE: To determine whether routine review by telephone of patients with asthma improves access and is a good alternative to face to face reviews in general practices. DESIGN: Pragmatic, randomised controlled trial. SETTING: Four general practices in England. PARTICIPANTS: 278 adults who had not been reviewed in the previous 11 months. INTERVENTION: Participants were randomised to either telephone review or face to face consultation with the asthma nurse. MAIN OUTCOME MEASURES: Primary outcome measures were the proportion of participants who were reviewed within three months of randomisation and disease specific quality of life, as measured by the Juniper mini asthma quality of life questionnaire. Secondary outcome measures included the validated "short Q" asthma morbidity score, nursing care satisfaction questionnaire score, and length of consultation. RESULTS: Of 137 people randomised to telephone consultation, 101 (74%) were reviewed, compared with 68 reviewed (48%) of the 141 people in the surgery group, a difference of 26% (95% confidence interval 14% to 37%; P<0.001; number needed to treat 3.8). Three months after randomisation the two groups did not differ in the Juniper score (risk difference -0.07 (95% confidence interval -0.40 to 0.27) or in satisfaction with the consultation (risk difference -0.07 (-0.27 to 0.13)). Telephone consultations were on average 10 minutes shorter than reviews held in the surgery (mean difference 10.7 minutes (12.6 to 8.8; P<0.001)). CONCLUSIONS: Compared with face to face consultations in the surgery, telephone consultations enable more people with asthma to be reviewed, without clinical disadvantage or loss of satisfaction. A shorter duration means that telephone consultations are likely to be an efficient option in primary care for routine review of asthma.

The burden of paediatric asthma is higher than health professionals think: results from the Asthma in Real Life (AIR) study.

AIM: To assess perceptions of children with asthma, parents of children with asthma and Health Care Professionals (HCPs) of asthma symptoms, lifestyle impairment, perceived control and treatment effects using the dataset provided within the AIR study.1 Method: Questionnaire based survey of 687 parents of children aged 0-14 with asthma, 579 children aged 9-14 with asthma and HCPs treating asthma (401 practice nurses and 809 GPs). RESULTS: Symptom frequency in patients was higher than expected by HCPs, as was reliever use - with 45% of patients using reliever three times per day. 65% described their asthma as "well controlled" yet of these: 37% had difficulty breathing, 34% nocturnal waking, 29% dry cough and 29 % ability to talk adversely affected by asthma at least weekly. CONCLUSIONS: HCPs underestimate asthma symptom prevalence and lifestyle limitation. Many children with asthma and parents appear to perceive significant levels of symptoms, lifestyle restriction and reliance on reliever medication as good control. This perception needs to be challenged if progress is to be made in improving patient outcomes.