Article type
Year
Abstract
Introduction/Objective: Elective surgery for varicose veins may be undertaken for patients with a range of severities, from those requiring cosmetic enhancement to those needing surgery for severe and recurrent varicose ulceration. In a vacuum of population based evidence, UK Health Authorities have attempted to ration access to procedures which offer purely cosmetic enhancement. One of the major challenges facing health services has been to assess the population healthcare needs for elective surgery. This project estimated the prevalence of venous disease, provided evidence of health needs and to studied the impact of policy guidelines incorporating patient preferences.
Methods: A postal screening questionnaire was sent to an age/sex stratified random sample of 26,000 individuals age 35 and over in Avon and Somerset. Those who reported varicose veins were invited for a detailed medical assessment, where the presence of varicose veins and ulcers, vascular status, comorbidity, patient preferences, priority for treatment and prior health service utilisation were determined. Concurrently guidelines for the management of varicose veins had been developed by an expert panel using the repertory grid technique yielding four categories of varicose veins ranging in order of priority from asymptomatic to severe. Combining these data it is possible to assess the impact of establishing a purchasing policy at each of the four levels of surgical priority in terms of size and cost of contract, and the numbers and characteristics of those who would be excluded, at each level of priority.
Results: 21,225 (82%) responded to the screening questionnaire. 1331 people attended for clinical examination of their veins. Using the four priority groups, the prevalence of asymptomatic veins was 94/10.000 (right side) and 105/10,000 (left side). 228/10,000 and 240/10,000 respectively were symptomatic but did not have skin changes (mild). The prevalence of symptoms with skin changes but no ulcer (moderate) was 302/10,000 and 311/10,000 respectively and severe venous disease involving ulceration was found for 38/10,000 (right side) and 42/10,000 (left side). Patient preferences and fitness for surgery are taken into account when determining the most appropriate treatment, (compression bandaging, injection sclerotherapy or surgery). The cost implications of each priority group are presented.
Discussion: Guidelines can be applied to large-scale population survey data to inform health services about population health care needs for common elective conditions, such as varicose veins and to provide much needed evidence when the prioritisation of services are under consideration.
Methods: A postal screening questionnaire was sent to an age/sex stratified random sample of 26,000 individuals age 35 and over in Avon and Somerset. Those who reported varicose veins were invited for a detailed medical assessment, where the presence of varicose veins and ulcers, vascular status, comorbidity, patient preferences, priority for treatment and prior health service utilisation were determined. Concurrently guidelines for the management of varicose veins had been developed by an expert panel using the repertory grid technique yielding four categories of varicose veins ranging in order of priority from asymptomatic to severe. Combining these data it is possible to assess the impact of establishing a purchasing policy at each of the four levels of surgical priority in terms of size and cost of contract, and the numbers and characteristics of those who would be excluded, at each level of priority.
Results: 21,225 (82%) responded to the screening questionnaire. 1331 people attended for clinical examination of their veins. Using the four priority groups, the prevalence of asymptomatic veins was 94/10.000 (right side) and 105/10,000 (left side). 228/10,000 and 240/10,000 respectively were symptomatic but did not have skin changes (mild). The prevalence of symptoms with skin changes but no ulcer (moderate) was 302/10,000 and 311/10,000 respectively and severe venous disease involving ulceration was found for 38/10,000 (right side) and 42/10,000 (left side). Patient preferences and fitness for surgery are taken into account when determining the most appropriate treatment, (compression bandaging, injection sclerotherapy or surgery). The cost implications of each priority group are presented.
Discussion: Guidelines can be applied to large-scale population survey data to inform health services about population health care needs for common elective conditions, such as varicose veins and to provide much needed evidence when the prioritisation of services are under consideration.