Background: Elastic compression stocking (ECS) therapy is well established in clinical practice for patients with deep venous thrombosis (DVT) and chronic venous disease (CVD). However, considerable variations exist for its implementation in clinical practice, which may impact patient outcomes. We previously identified six improvement themes for optimization of ECS therapy using the Functional Resonance Analysis Method (FRAM).
Aims: This study aims to expand theoretical understanding using a realist evaluation to refine the initial improvement theory and thereby improve chances for implementation.
Methods: The realist evaluation included a mixed-method design consisting of semi-structured interviews with patients (n=5) and involved health care professionals (n=25), stakeholder meetings (n=2), and surveys (n=114). The study was approved by the recognized medical ethical committee of MUMC+ and all participants gave verbal informed consent. Both quantitative and qualitative data were extracted to create the content of context-mechanism-outcome-configurations (CMOcs) important in ECS therapy. The study was funded by a grant from ZonMw, the Netherlands Organisation for Health Research and Development.
Results: We identified seven CMOcs that should be used to inform implementation strategies to support the implementation and optimization of ECS therapy. These CMOcs targeted four optimal outcomes: type of initial compression therapy with maintenance of patient’s self-reliance, selection of ECS material, maintenance of patient’s self-reliance using assistive devices, follow-up (for DVT- and CVD-patients), and duration of ECS therapy (for DVT-patients). Furthermore, the main clinical care pathways for ECS therapy and associated patient volumes were identified, providing insight into the potential impact of various strategies.
Conclusions: This study provides a detailed insight into what needs to be in place to optimize ECS-therapy and to inform implementation strategies.
To cite this abstract in AMA style:Schreurs RH, Joore MA, De Bruijn-Geraets D, Ten Cate H, Ten Cate-Hoek AJ. A Realist Evaluation on Therapeutic Elastic Compression Therapy Pathways for DVT- and CVD Patients to Develop Evidence-informed Improvement Strategies [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/a-realist-evaluation-on-therapeutic-elastic-compression-therapy-pathways-for-dvt-and-cvd-patients-to-develop-evidence-informed-improvement-strategies/. Accessed January 26, 2022.
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