. 2017 Aug 2;14(6):1189–1198. doi: 10.1111/iwj.12784

Table 2.

Participants' perspectives on the evaluation

Mississauga Halton CCAC perspective	South West CCAC perspective
MH CCAC is committed to working collaboratively with our partners in the delivery of evidenced‐informed care that supports excellent patient outcomes, enhances the patient experience and balances clinical efficacy with cost efficiency. To evaluate the geko™ device, MH CCAC selected chronic hard‐to‐heal patients with multiple comorbidities. The wound improvements had an overall positive impact on the patients' experience with their wound care. Based on this, MH CCAC is adding the device to their medical supplies and equipment formulary. Furthermore, we believe that its use should not be limited to only those patients with chronic non‐healing wounds, where all other therapies have failed. The implementation of innovative approaches to wound care such as the geko™ device should be considered as an adjunctive therapy. Work is underway to develop a policy and procedure for the use of geko™ to ensure the right patients have access to the device at the appropriate time in their care. Further analysis is also needed to understand whether geko™ has an influence on the frequency of nursing visits.	The South West CCAC appreciated the opportunity to partner in this evaluation of the geko™ device. When enrolled, these chronic hard‐to‐heal patients with venous leg ulcers and multiple comorbidities and the caregivers had low expectations of improvement. However, study participants identified wound improvements as well as an overall positive impact on quality of life. Although SWCCAC has not added the device to their formulary now, they are committed to developing a framework to guide the process of offering and evaluating the effectiveness of alternative and adjunctive wound care therapies. It is important to consider Nursing capacity to develop expertise in this and other alternative and adjunctive wound care therapies. Patient selection criteria need to be clearly established for adjunctive therapy. If the primary wound healing protocol is not being followed, for example off‐loading, compression, nutrition and diabetes management, the adjunctive treatment effectiveness will be suboptimal. Finally, it is necessary to have clear outcome indicators to guide decision making when this device should be discontinued and what next stage protocol is appropriate.
An additional benefit of this evaluation is that MH CCAC's medical supply and equipment committee now has a process for evaluation and adoption of new heath care innovations.

Mississauga Halton CCAC perspective

South West CCAC perspective

MH CCAC is committed to working collaboratively with our partners in the delivery of evidenced‐informed care that supports excellent patient outcomes, enhances the patient experience and balances clinical efficacy with cost efficiency. To evaluate the geko™ device, MH CCAC selected chronic hard‐to‐heal patients with multiple comorbidities. The wound improvements had an overall positive impact on the patients' experience with their wound care. Based on this, MH CCAC is adding the device to their medical supplies and equipment formulary. Furthermore, we believe that its use should not be limited to only those patients with chronic non‐healing wounds, where all other therapies have failed. The implementation of innovative approaches to wound care such as the geko™ device should be considered as an adjunctive therapy. Work is underway to develop a policy and procedure for the use of geko™ to ensure the right patients have access to the device at the appropriate time in their care. Further analysis is also needed to understand whether geko™ has an influence on the frequency of nursing visits.

The South West CCAC appreciated the opportunity to partner in this evaluation of the geko™ device. When enrolled, these chronic hard‐to‐heal patients with venous leg ulcers and multiple comorbidities and the caregivers had low expectations of improvement. However, study participants identified wound improvements as well as an overall positive impact on quality of life. Although SWCCAC has not added the device to their formulary now, they are committed to developing a framework to guide the process of offering and evaluating the effectiveness of alternative and adjunctive wound care therapies. It is important to consider Nursing capacity to develop expertise in this and other alternative and adjunctive wound care therapies. Patient selection criteria need to be clearly established for adjunctive therapy. If the primary wound healing protocol is not being followed, for example off‐loading, compression, nutrition and diabetes management, the adjunctive treatment effectiveness will be suboptimal. Finally, it is necessary to have clear outcome indicators to guide decision making when this device should be discontinued and what next stage protocol is appropriate.

An additional benefit of this evaluation is that MH CCAC's medical supply and equipment committee now has a process for evaluation and adoption of new heath care innovations.

Nursing service provider perspective	Physician perspective
This successful project involved key partners who made a commitment to collaborate in the evaluation, investing time and resources. Factors for success included the number and type of patients and length of time required for the evaluation, co‐ordination and dedication of the Wound Care Specialist and Wound Resource Nurse visits, collaboration with the physician, reporting at set intervals of time, additional education for nurses and patients, keeping patient confidentiality within the parameters of the patient consent, regular teleconferences or face to face meetings as the study progressed, for sharing of information (successes and challenges), performing the evaluation of the patient experience and additional cost to the agency, which reimbursed the nurses to attend meetings, and compensated for longer visits required for the evaluations. The goal was patient centred with the hope that wounds would heal timely resulting in an improved quality of life, and they felt that this was achieved.	Most of the patients evaluated in the South West represent patients with multiple comorbid conditions and complex lower extremity oedema. Most had limited calf muscle pump function and poor walking tolerance. In general, they were intolerant of adequate compression therapy. The device should help to stimulate both venous and lymphatic return through muscle contractions. The trial describes a real‐life evaluation in a home care setting, which presents challenges of consistency of care and patient adherence to care plans. As well, despite the use of a fillable iPad form consistent with forms already in use, with multiple persons entering data there are often missing data points. The only significant adverse effect was rash related to the glue used to adhere the device. This is being addressed by the developer. Given all these challenges the data suggest that it is reasonable to further evaluate this device in a controlled trial.

Nursing service provider perspective

Physician perspective

This successful project involved key partners who made a commitment to collaborate in the evaluation, investing time and resources. Factors for success included the number and type of patients and length of time required for the evaluation, co‐ordination and dedication of the Wound Care Specialist and Wound Resource Nurse visits, collaboration with the physician, reporting at set intervals of time, additional education for nurses and patients, keeping patient confidentiality within the parameters of the patient consent, regular teleconferences or face to face meetings as the study progressed, for sharing of information (successes and challenges), performing the evaluation of the patient experience and additional cost to the agency, which reimbursed the nurses to attend meetings, and compensated for longer visits required for the evaluations. The goal was patient centred with the hope that wounds would heal timely resulting in an improved quality of life, and they felt that this was achieved.

Most of the patients evaluated in the South West represent patients with multiple comorbid conditions and complex lower extremity oedema. Most had limited calf muscle pump function and poor walking tolerance. In general, they were intolerant of adequate compression therapy. The device should help to stimulate both venous and lymphatic return through muscle contractions. The trial describes a real‐life evaluation in a home care setting, which presents challenges of consistency of care and patient adherence to care plans. As well, despite the use of a fillable iPad form consistent with forms already in use, with multiple persons entering data there are often missing data points. The only significant adverse effect was rash related to the glue used to adhere the device. This is being addressed by the developer. Given all these challenges the data suggest that it is reasonable to further evaluate this device in a controlled trial.