Tijd, liefde en aandacht helen niet alle wonden

The concept of integrated care, which implies a team of medical specialists, general physicians, specialized nurses and psychologists, is increasingly advocated, but often without appropriate high level evidence. Two independent and high quality multicenter randomized clinical trials evaluated the benefits of the integrated care model compared to usual care for venous leg ulcers and chronic hand dermatitis in the Netherlands. Adherence to compression stockings in patients with venous leg ulcers remained low in the integrated care and control groups. After 18 months, the likelihood of developing a recurrent ulcer was comparable in both groups. Additional care and counselling decreased the Hand Eczema Severity Index in patients with severe hand dermatitis, but the difference does not seem to be clinically relevant. Although the concept of integrated care programs sounds promising, the benefits for hand dermatitis and venous leg ulcers are disappointing and are not likely to be cost-effective.

Conflict of interest and financial support: a disclosure form provided by the author is available with the full text of this article at www.ntvg.nl, search for A5464.