Towards improved organisation of care: improving compression therapy for patients with DVT and CVD (CEAP 3-5)

In the Netherlands, a large variation in organization of compression therapy exists for patients with deep venous thrombosis (DVT) and chronic venous disease (CVD). The IDEAL-DVT study conducted earlier showed that for patients with deep venous thrombosis (DVT), an individualized therapy with elastic compression stockings (ECS) was non-inferior to a standardized treatment duration of 24 months in preventing post-thrombotic syndrome. This approach could save at least 30 million euro per treatment episode. However, this approach is not yet implemented in the entire country. Furthermore, the implementation of assistive devices to apply and remove the ECS, and initial compression therapy types prescribed are variable. This thesis identified 19 targets for improvement to optimize the organization of ECS therapy in The Netherlands based on three studies performed: a Functional Resonance Analysis Method (FRAM), a Realist Evaluation and a modified Delphi analysis.
Consensus was reached regarding these statements among national stakeholders and patients. Three main targets for improvement were identified: 1) optimizing initial compression therapy to remain self-reliance, 2) early consultation of an occupational therapist to train the patient how to use an assistive device, and 3) a tailored duration of elastic compression stocking therapy. A budget impact analysis showed that the improvements resulted in considerable cost savings within three years after implementation for two of the three regions included in this study. Finally, an interdisciplinary cross-domain protocol was developed targeting treatment decisions, communication, and roles and responsibilities regarding the process.