PAMCAI supports practice changes that translate to improved patient adherence, highlighting the potential value of clinician-focused decision-aids in venous leg ulcer care.
Key Findings
Results
Clinicians using PAMCAI demonstrated significantly higher documentation scores across all three categories compared to clinicians not using PAMCAI.
The three documentation categories assessed were: documentation of adherence and frequency of wear, identification of patient-specific barriers, and attempts to address barriers.
Differences in documentation scores were statistically significant for all three categories (p < 0.001).
The study analyzed 36 medical records from 18 patients, with each patient contributing records from both PAMCAI and non-PAMCAI clinical encounters.
Clinicians were occupational therapists, and comparisons were made within a prospective comparative cohort study embedded in a pilot randomized controlled trial.
Results
Improvements in patient compression stocking adherence were positively associated with higher documentation quality in the targeted categories.
The association between documentation quality and patient adherence improvement was statistically significant (p < 0.001).
This finding suggests that more thorough clinician documentation of barriers and wear frequency is linked to better patient adherence outcomes.
The relationship was explored across the same 36 medical records from 18 patients.
Methods
The study design embedded a prospective comparative cohort study within a pilot randomized controlled trial to examine clinician practice and patient adherence.
Clinical notes from occupational therapists using PAMCAI were compared with notes from the same or comparable therapists not using PAMCAI.
The study focused on venous leg ulcer patients for whom compression stocking adherence is critical to reducing ulcer recurrence.
PAMCAI stands for Personalized and Multidimensional Compression Assessment and Intervention and is described as a novel digital clinical decision-aid.
The sample consisted of 18 patients contributing a total of 36 medical records.
Background
Low adherence to compression stocking wear remains a persistent clinical problem associated with venous leg ulcer recurrence.
The paper identifies compression stocking adherence as 'essential for reducing venous leg ulcer recurrence.'
Despite its importance, 'adherence rates remain low' according to the background context of the study.
This gap in adherence motivated the development and testing of the PAMCAI decision-aid as a clinician-focused intervention.
Conclusions
PAMCAI was found to support clinician practice changes that translated to improved patient adherence with compression stocking use.
The authors conclude that the decision-aid produced measurable changes in clinician documentation behavior.
These practice changes were in turn associated with improved patient-level adherence outcomes.
The findings highlight 'the potential value of clinician-focused decision-aids in venous leg ulcer care.'
The study positions PAMCAI as a tool that operates by changing clinician behavior as an intermediate step toward improving patient outcomes.
What This Means
This research suggests that a digital tool called PAMCAI (Personalized and Multidimensional Compression Assessment and Intervention) can help healthcare providers — specifically occupational therapists — do a better job of supporting patients who need to wear compression stockings to prevent leg ulcers from coming back. The study found that when clinicians used PAMCAI, they were much more likely to document important information in patient records, including how often patients were wearing their stockings, what was getting in the way of consistent wear, and what steps were taken to address those barriers. These improvements were statistically significant, and higher-quality documentation was linked to better patient adherence to stocking use.
The study involved 18 patients and analyzed 36 sets of clinical notes — comparing records created with PAMCAI to those created without it. By embedding a comparative study within a small randomized controlled trial, the researchers were able to examine how the tool changed clinician behavior and whether that behavior change made a difference for patients. The finding that better documentation predicted better patient adherence suggests that the tool works by prompting clinicians to have more thorough, personalized conversations with patients about their specific challenges.
This research matters because venous leg ulcers are a common and difficult-to-treat condition, and recurrence is strongly tied to whether patients consistently wear compression stockings — something many patients struggle to do. This study suggests that equipping clinicians with structured, personalized decision-support tools may be a promising strategy for improving patient adherence in wound care and potentially in other areas where long-term self-management is essential.
Bar L, Brandis S, Wenke R, Marks D. (2026). A Decision-Aid Improves Clinician Practice and Associated Patient Compression Stocking Adherence.. International wound journal. https://doi.org/10.1111/iwj.71035