Table 7 Research recommendations for future studies on the effect of telemedicine follow-up care of leg and foot ulcers based on EPICOT format

E

Evidence

What is the current evidence?

One small study (n = 140) with a non-randomized design conducted in the United States.

P

Population

Patients (>20 years) presenting a leg ulcer or diabetes-related foot ulcer to specialist health care.

I

Intervention

Telemedicine follow-up care provided by municipal primary health care in collaboration with specialist health care

C

Comparison

Placebo, routine care, alternative treatment/management

Care as usual.

O

Outcome

Which clinical or patient related outcomes will the researcher need to measure, improve, influence or accomplish? Which methods of measurement should be used?

Healing time; total number of consultations per person; sequelae directly related to the foot or leg ulcer: infection, hospitalization, and vascular surgery during the study; patient satisfaction with health care; health status and cost utility; the time elapsing before a new ulcer appears, the incidence of amputation and survival.

T

Time stamp

Date of literature search or recommendation

May 16th, 2014.

d

Disease burden

Leg ulcers and diabetes-related foot ulcers are longstanding and costly complications of their underlying diseases and represent challenges for individual people and health care system. Treatment of leg ulcers and diabetic foot ulcers often demands frequent contact with the health care system and may pose a great burden on the patient. According to international guidelines patients with leg or foot ulcers should be referred to specialist foot clinics at an early stage. However, in Norway as well as other European countries many foot ulcer patients are treated a substantial time in primary care with lack of expert nurses and doctors and access to specialist health care, which may be problematic as they may not be using the evidence base sufficiently well to support ulcer healing and patient well-being.

t

Timeliness

Time aspects of core elements:

Mean age of the population

67 years

Duration of the intervention

12 months

Length of follow-up

3 years

s

Study type

What is the most appropriate study design to address the proposed question

Cluster- randomized controlled trial