Influences on patient adherence with compression hosiery

Abstract

Compression hosiery plays a vital role in preventing leg ulcer recurrence, but many patients choose not to wear it. This review identifies the factors that may be responsible for this and suggests how the problem can be overcome.

Clinician's perspectives on the treatment of venous leg ulceration

“…In line with previous research (19,22,24–28), significant levels of patient non compliance are reported…”

“… The ulcer and the underlying chronic venous insufficiency are acknowledged as difficult to treat and determining the best approach is not straightforward Many clinicians feel dissatisfied with the care that they can provide for patients with VLU Current compression therapy is not uniformly effective There is inconsistency in the outcomes delivered by compression therapies There was little sign of common treatment approaches or the emergence of any single ‘standard’ In line with previous research (19,22,24–28), significant levels of patient non compliance are reported Treating VLU can be a very rewarding experience for the clinician, but this is often the exception. The greatest degree of feedback from clinicians was of an experience that is dissatisfying and frustrating Clinician dissatisfaction relates to the difficulty in overcoming the key challenges they report; patient compliance and motivating/educating them, dealing with oedema and the chronicity of the underlying condition …”

“…Much is written in the literature about the nature of patient compliance particularly with compression. Many authors conclude that it is not the task of the clinician to coerce or enforce the unwilling patient (16,19,22,23,26,27,30,31) but to create a shared venture in which the patient chooses to participate in their therapy. Yet frustration about how to educate and motivate the patient can lead to a situation in which the patient is ‘blamed’ or even pre‐judged in advance for their actual or even predicted lack of compliance (28).…”

“…However, clinicians may not currently have the time, the means or the motivation to be able to obtain this level of patient cooperation. Arguably, even if they did, patient compliance may relate to many other factors (19,22,26,27,30) such as the social impact that current compression therapies have on the patient in restricting their abilities to participate in and enjoy everyday activities. Third, how well are health care systems actually serving the patient and the clinician?…”

The impact of psychosocial factors on adherence to compression therapy to prevent recurrence of venous leg ulcers

“…Lifelong compression therapy is the primary conservative strategy to prevent recurrence, yet in practice, the use of long‐term compression is associated with multiple difficulties and poor rates of adherence (Flaherty 2005). Patients report that compression garments are uncomfortable, costly and difficult to apply (Moffatt & Dorman 1995, Harker 2000, Anand et al. 2003, Seppanen & Livanainen 2005).…”