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The Ulcus Cruris Care project developed a disease- management approach to support evidence-based venous leg ulcer treatment in general practices. This included online training and three e-learning modules for practice teams, software-supported case management, involvement of non-physician assistants, and promotion of patient activation and education. The intervention program was implemented within a multicenter randomized controlled trial (Ulcus Cruris Care). A mixed-methods process evaluation explored intervention fidelity and perceived effects to identify improvement potential.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The cross-sectional process evaluation design applied semi-structured guide-based qualitative telephone interviews and a study-specific survey to evaluate the implementation process of the program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200938 survey questionnaires were completed and\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200927 interviews were conducted (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910 general practitioners,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910 non-physician assistants,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097 patients). Findings indicate high intervention fidelity regarding completion of the online training (100%), the e-learning modules (between 61% and 48%), application of standard operating procedures (100%), patient education material (91%), and case management software (91%). Practice teams and patients positively perceived the role of non-physician assistants as case managers and their involvement in wound treatment and patient education. Overall, the program was perceived as effective in promoting change in treatment routines, particularly the regular use of compression therapy as the most effective treatment measure, improving patient and practice team education, and ultimately, wound healing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The intervention program was expected to increase the use of compression therapy, speed up healing, and reduce the use of medical resources. Participants in this process evaluation perceived the program as supporting structured venous leg ulcer treatment, increasing relevant knowledge among practice teams and patients, and encouraging more active involvement of patients and relatives. The outcome analysis in the Ulcus Cruris Care trial strengthened these findings and suggested a potential benefit of the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Promotion of comprehensive VLU treatment and care in general practices, including a regular use of compression therapy and active patient participation as facilitated by this intervention program appears to be largely suitable for a venous leg ulcer case management approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The Ulcus Cruris Care trial protocol was registered in the German Clinical Trials Register on August 30, 2021 (DRKS00026126).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-026-14674-0","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:15:28Z","timestamp":1778152528000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementing a primary care disease management concept for venous leg ulceration: findings of a mixed-methods process evaluation in the Ulcus Cruris Care trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Regina","family":"Po\u00df-Doering","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Fleischhauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Sander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunter","family":"Laux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Wensing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Szecsenyi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas. 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Written informed consent was obtained from all subjects involved in this process evaluation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"UCC is a publicly funded research project (funding code: 01VSF19043). J.D.S and J.S share the project management, T.F. is a doctoral student in the project. N.S. wrote her master\u2019s thesis in Clinical Research (Department for Health Sciences, Medicine and Research, University for Continued Education, Krems, Austria) based on 5 GP, 5 MA and 5 patient interviews included in this present study, and supported the UCC project as research assistant. All authors declare no competing interests. The funder had no role in the design of the study, the collection, analyses, or interpretation of data, the writing of the manuscript, or in the decision to publish the results.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"664"}}