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Abstract
Despite progress in the last two decades, chronic venous disease remains understudied and severely underestimated for its effect on public health. Venous leg ulcers (VLUs) are a common and costly problem worldwide. The burden of VLUs is expected to rise with an ageing population and the growing epidemic of diabetes and obesity, which coupled with chronic venous insufficiency (CVI) will reduce quality of life and increase health care costs. The main treatment for VLUs is a firm compression bandage to aid venous return. Variation in assessment, diagnosis and management of VLUs may mean delayed diagnosis, overuse of antibiotics and insufficient or inadequate use of compression therapy. Given the variation of care and the need to improve management of people with VLUs, there is an urgent need to develop and test clinical indicators to measure VLU outcomes. Significant variations predispose clinical practice that may not follow best practice guidelines. There is a need to monitor patterns and quality of care for people diagnosed with VLUs in Australia. The rationale for establishing a clinical quality registry is to improve quality and safety of care.

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Abstract
Chronic venous disorders are increasingly being recognised as a health care priority in the Western world. The burden of venous ulceration is growing due to increased prevalence of venous disease, diabetes and obesity. A wide variety of health professional specialities are responsible for the prevention, diagnosis and treatment of venous leg ulcers (VLUs). Each discipline may have a different approach to preventing, diagnosing and treating venous disease depending on their practice, experience and training. Best practice treatment of VLUs is a firm compression bandage to aid venous return. Variability in clinical practice and variable quality of care as well as lack of standard guideline implementation and compliance can affect VLU healing outcomes. Monitoring patterns and quality of care for people diagnosed with VLUs with a national quality registry has been shown to improve quality outcomes for people in Sweden. This article outlines the positive healing outcomes from the Swedish Registry of Ulcer Treatment (RUT) and offers some reflections about how this learning can be applied to the Australian setting.

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Abstract
This article will briefly discuss variation in practice, and the difficulty of implementing evidence into practice across the health sector broadly, and more specifically related to venous leg ulcers (VLUs). An overview of the issues related to implementation of evidence into practice will be provided, with suggestions that a clinical registry can be one tool to support the systematic uptake of evidence into practice in the care of people with VLUs.

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Abstract
Venous thromboembolism (VTE) consists of deep vein thrombosis (DVT) and pulmonary embolism (PE) and is a major cause of disease burden in Australia. A prospective study conducted in Perth, Western Australia, estimated the age-adjusted annual incidence of VTE to be 0.57 (95% CI, 0.47–0.67) per 1000 residents1. There were over 14,700 cases of VTE in Australia in 2008, contributing to an estimated financial cost of $1.72 billion for that year2. Post-thrombotic syndrome (PTS) is a frequently overlooked chronic complication of DVT, specifically proximal DVT (occurring at or above the popliteal vein). It is a clinical syndrome encompassing the presence of chronic pain, swelling, skin discolouration and, in severe cases, venous ulceration. It affects approximately one-third of patients following DVT, and about 5% to 10% of patients progress to severe PTS3,4. It is the cause of significant morbidity and health care utilisation.

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Abstract
To better understand long-term adherence to self-care activities to prevent the recurrence of venous leg ulcers (VLUs), participants (n=80) were recruited to a prospective longitudinal study after experiencing healing of a VLU. Data on demographics, health, psychosocial measures and adherence to prevention strategies (compression therapy, leg elevation and lower leg exercise) were collected every three months for one year after healing. Multivariable regression modelling was used to identify the factors that were independently associated with adherence.
Over the year, a significant decline in adherence to all three strategies was observed, predominantly between 6 and 12 months after healing (p<0.01). Several factors were associated with adherence to more than one preventive activity. Regular follow-up care and a history of multiple previous ulcers were related to improved adherence (p<0.05), while scoring at higher risk for depression and restricted mobility were related to decreasing adherence over time (p<0.05). Patients with osteoarthritis had significantly reduced adherence to compression hosiery (p=0.026). These results provide information to assist care providers plan strategies for prevention of recurrent VLUs; and suggest a need for regular followup care which addresses both the physical and mental health of this population.

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Abstract
People who live with chronic wounds have many stories to tell and people with venous leg ulcers (VLUs), in particular, have significant stories, as their experiences are typically prolonged and recurrent. The story reported in this paper highlights a range of experiences known to be associated with this condition, including a negative impact on wellbeing and financial expense. This story adds to what is known by illuminating the position of today’s health care consumer who seeks more involvement and engagement in their management and care. Optimising self-management was shown in this story to be highly important, in particular the benefits of self-treating the VLU. Having a sense of control, satisfaction from being able to self-care, and the flexibility to do so when and for how long one wishes, are perceived benefits of wound self-treatment. There is little published about self-treatment of chronic wounds and this topic requires further investigation. With an ageing population and increasing numbers of younger Australians living with chronic health conditions, not only is this likely to be a growing preference of wound management consumers, it is also likely in part to be a solution to the growing pressures on health care budgets and expenditure.

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Abstract
Over one third of Australia’s medical workforce works at the primary care level in the General Practice setting1. This large component of the work force is the gate keeper for our medical system and is ideally placed to provide best evidence management to patients suffering Venous Leg Ulcers [VLUs] to improve patient well being while healing the wound. Primary care in general has the potential to achieve the goal of reducing the incidence of VLUs by 50% in 10 years. There are many challenges to achieving this goal which will be explored in this paper with suggested actions to maximise this potential.

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Abstract
It has been acknowledged that regional and rural areas may have limited access to expert wound management education and expertise. Historically in community nursing across Victoria no formal pathways existed for regional and metropolitan services to collaborate. Efforts to develop wound education were occurring in isolation and potentially being duplicated. The Connected Wound Care project, an initiative funded by the Department of Health, Victoria, initiated meaningful collaboration between Regional Wounds Victoria and the Royal District Nursing Service. This enabled gaps in wound management practice in the community setting to be identified and addressed. Initially a suite of health care guides and a diabetes foot kit, addressing aspects of wound prevention and management, was developed. More recently, focus on interpreting aspects of the Australian and New Zealand Clinical Practice Guideline for the Prevention and Management of Venous Leg Ulcers into practice, led to the development of an e-learning package. All of these resources were distributed to over 270 agencies across Victoria. This paper will show that effective, collaborative relationships can be established between traditional ‘silo’ agencies. Shared insight into wound management across a state environment can occur and outcomes which positively impact the individuals we care for are achievable together.

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Abstract
Abstracts of the 10th Biennial Australian Wound Management Association National Conference,
7-10 May 2020,
Gold Coast Convention and Exhibition Centre,
Gold Coast, Queensland, Australia

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