In 2009 an overhaul of lymphoedema Services in Northern Ireland to provide dedicated lymphoedema to both cancer and non-cancer related lymphoedema patients took place across the province.
In the last ten years the landscape of chronic oedema, lymphoedema and lipoedema has broadened significantly; demand for services has far exceeded capacity. This coupled with reduced management of chronic oedema in primary care, lead to inappropriate referrals into lymphoedema and tissue viability services.
This project aimed to scope and rectify these problems with the development of healthy leg clinics based in general practitioners practices.
An initial scoping project was undertaken to review GP coding for patients presenting with leg oedema, develop a pathway and patient information leaflets, and gather staff and patient opinions on management of leg oedema.
Results from this were developed into a funding proposal to establish healthy leg clinics in GP practices supported by a chronic oedema liaison therapist.
In the first 12 practices 55 GP´s, pharmacists and practice nurses were trained, and 35 clinics booked.
For the first 22 patients seen in the pilot study prescribing savings of £597per year were calculated through the correct prescribing of hosiery.
Furosemide had been commenced in 6/22 of patients identified. De-prescribing potentially reduced adverse effects of long term diuretic use.
A life impact scale was used to capture patient outcomes, 100% patients were "very pleased with the service", reporting the best aspect as the opportunity to get information on how to help their condition. All patients found the negative impact of their swelling reduced as a result of the care received.
This project has demonstrated benefits in patient and staff education/awareness, prescribing savings, appropriate de-prescribing and patient satisfaction. Measurement of long range data (reduction in referrals to secondary care, and prevention of complex conditions) have not been possible to achieve within this project time frame, however, early management and increased patient/clinician understanding of the condition would suggest that this is achievable.
Through regional networks we are aware that this is a regional problem. There is an uncoordinated approach to whose remit it is to manage these patients.
This pilot evidences the benefit of seeing patients in the community; skilling up practice nurses and community pharmacists to provide early intervention. With relatively small amount of training and ring-fenced funding considerable costs savings and patient benefits can be achieved. This will result in long term benefits for patients; reduced use of antibiotics and diuretic therapy, efficient use of district nursing resources and reduced admissions into acute services due to cellulitis.
Funding was received from South Eastern Health and Social Care Trust and Local Commissioning Group.
This work was presented at Physiotherapy UK 2019