OBJECTIVE: This long-term follow-up recorded the prevalence, aetiology and treatment of hard-to-heal leg and foot ulcers, and an estimated nurses' time spent providing care, for the years 1994-2005. METHOD: A questionnaire was sent to all district and community nurses in the county of Blekinge, Sweden, during one week in 1994, 1998, 2004 and 2005. Calculating the costs of hard-to-heal leg and foot ulcer care was not a primary aim, but the reduction in prevalence and time spent on wound management suggested it was important to illustrate the economic consequences of these changes over time. RESULTS: Estimated prevalence of hard-to-heal leg and foot ulcers reduced from 0.22% in 1994 to 0.15% in 2005. Treatment time decreased from 1.7 hours per patient per week in 1994 to 1.3 hours in 2005. Annual costs of leg and foot ulcer care reduced by SEK 6.96 million in the study area from 1994 to 2005. CONCLUSION: Improved wound management was demonstrated; leg and foot ulcer prevalence and treatment time were reduced. The results could be attributed to an increased interest in leg and foot ulcer care among staff, which was maintained by repeated questionnaires, continuous education, establishment of a wound healing centre in primary care and wound management recommendations from a multidisciplinary group. The improved ulcer care reduced considerably the annual costs of wound management in the area.
GENESIS (General Ethnographic and Nursing Evaluation Studies In the State) is a tested and proven community analysis strategy that integrates ethnographic and epidemiologic data to arrive at a comprehensive, holistic description of the health of a community and its residents. Communities analyzed in most project GENESIS studies have been rural or semirural. ACTION (Assessing Communities Together in the Identification Of Needs) is an extension of the GENESIS community analysis model that was developed to meet the unique needs of community-level research and analysis in an urban, multicultural setting. Significant differences in the context in which the ACTION projects took place necessitated extensions in specific components of the GENESIS model. Application of the GENESIS model by the ACTION team is described. Based on the experiences with ACTION, recommendations are offered for future urban, multicultural community analysis projects.