Noncompliance with guidelines on the use of ultrasound and pentoxifylline in the treatment of venous ulcers in a rural healthcare system.

Guidelines based on randomized controlled data recommend patients with newly diagnosed venous leg ulcers (VLUs) undergo venous reflux duplex ultrasound (VRDUS) and be considered for treatment with pentoxifylline to accelerate ulcer healing. A retrospective review was conducted of 2,061 patients with VLU, diagnosed between 2011 and 2020 in a rural healthcare system, to identify factors associated with increased or decreased likelihood of being prescribed VRDUS and pentoxifylline. VRDUS (16%) and pentoxifylline (0.7%) were infrequently prescribed. Evaluation by a vascular specialist was associated with a significantly increased frequency of undergoing VRDUS (5% to 38%). Seeing a wound care specialist was associated with an increased frequency of being prescribed pentoxifylline (0.7% to 1.4%). Increased referral to specialists and/or referring clinician education on guideline-based care may be of benefit to patients with VLUs. Pentoxifylline appears underutilized, even by specialists. Further study is needed to confirm these findings and determine if they are generalizable.