ABSTRACT
Eri Fukaya, MD, PhD
Clinical Associate Professor
Stanford University
Palo Alto, California, United States
Compression therapy is the mainstay for venous leg ulcers (VLU) with a Grade 1A recommendation for VLU healing and recurrence prevention. However, gaps in knowledge of the provider can result in suboptimal treatment. Thus, it is imperative to have standardized training and education for compression therapy providers. In 2002, the Japanese Society of Phlebology (JSP) developed the Compression Education Committee (CEC) with the goal of providing education and training for providers to perform compression therapy for chronic venous disease, VLUs, lymphedema and venous thromboembolism (VTE) prevention. The CEC provides educational and hands on training courses. Following the training course, passing a competency examination and submitting clinical case documentation, participants are certified. A facility with a certified provider can receive reimbursement for services.
Our goal in this study is to aggregate 20 years of data to describe (1) Who provides compression therapy to patients in Japan, (2) Provider to population ratio, (3) How CEC efforts may have affected clinical practice and outcomes, (4) How reimbursement policies affect medical treatments.
Methods:
We gathered demographic data of participants of the CEC educational courses from 2002 to 2022 including occupational title of participants and their geographical location in Japan to estimate the ratio of providers to the population nationwide. We also compared this to best clinical practices and outcomes of VTE that have been reported during this time frame.
Results:
In 20 years, 140 courses were provided by CEC. As of March 2022, there are 3200 certified therapists (789 renewed, >1000 take the course annually without certifying) throughout Japan (population 125 million). This breakdown include 1236 nurses, 646 physicians, 45 nursing assistants, 59 clinical technicians, 37 physical therapists, 3 occupational therapists, 10 other medical personnel and unknowns. Certified providers were more frequent in highly populated areas and one third of the 47 prefectures had less than 20 providers reflecting differences in access to care. The number of perioperative pulmonary embolism cases dropped from 1 in 10,000 prior to 2002 to 0.4-0.6 in 10,000 cases in and after 2004, following implementation of CEC. Medical reimbursement for compression therapy became available for VTE prevention in 2004 and for VLUs in 2020 both of which affected provider certification numbers
Conclusions:
Over the past 20 years, CEC provided standardized education and training for compression therapy providers. This allowed for nurses, physicians and other ancillary staff who are the providers for compression therapy to obtain/update knowledge and information leading to overall quality improvement of venous and lymphatic care.