Opportunities for better value wound care: a multiservice, cross-sectional survey of complex wounds and their care in a UK community population

Abstract

BackgroundComplex wounds impose a substantial health economic burden worldwide. As wound care is managed across multiple settings by a range of healthcare professionals with varying levels of expertise, the actual care delivered can vary considerably and result in the underuse of evidence-based interventions, the overuse of interventions supported by limited evidence and low value healthcare.ObjectivesTo quantify the number, type and management of complex wounds being treated over a two-week period and to explore variations in care by comparing current practices in wound assessment, prevention and treatment.DesignA multiservice cross-sectional survey.SettingThis survey spanned eight community services within five Northern England NHS Trusts.ResultsThe point prevalence of complex wounds in this community-based population was 16.4 per 10 000 (95% CI 15.9 to 17.0). Based on data from 3179 patients, antimicrobial dressings were being used as the primary dressing for 36% of patients with complex wounds. Forty per cent of people with leg ulcers either had not received the recommended Doppler-aided Ankle Brachial Pressure Index assessment or it was unclear whether a recording had been taken. Thirty-one per cent of patients whose most severe wound was a venous leg ulcer were not receiving compression therapy, and there was limited use of two-layer compression hosiery. Of patients with a pressure ulcer, 39% were not using a pressure-relieving cushion or mattress.ConclusionsMarked variations were found in care, underuse of evidence-based practices and overuse of practices that are not supported by robust research evidence. Significant opportunities for delivering better value wound care therefore exist. Efforts should now focus on developing strategies to identify, assess and disinvest from products and practices supported by little or no evidence and enhance the uptake of those that are.

MnSOD is implicated in accelerated wound healing upon Negative Pressure Wound Therapy (NPWT): A case in point for MnSOD mimetics as adjuvants for wound management

“…Wound healing is an important clinical challenge worldwide, and a lot of research has been done in this field in the past decades. Despite the number of published studies, the molecular mechanisms underlying the different phases of wound healing remain insufficiently understood [3] , [4] . This is due to the complexity of wound healing, which comprises overlapping phases of inflammation, proliferation and remodelling, and the involvement of a multitude of cell types intervening in tissue repair.…”

“…Wound management already represents a significant economic burden on healthcare systems, which is expected to increase significantly due in part to better life expectancy, and therefore, the probability of prolonged care for chronic diseases that amplify the risk for acute and/or chronic wounds. As such, there is a heightened realization to design better and effective therapeutic strategies in order to achieve more optimized and efficient wound healing [3] , [4] .…”

Use of antimicrobial dressings in England and the association with published clinical guidance: interrupted time series analysis

“…Temporal changes in dressing use and expenditure may also be influenced by demographic and epidemiological factors (eg, an ageing population and the rise in chronic diseases such as diabetes) 37. The prescribing data are not wound-specific and limited to English community prescriptions; however, we note that the community is where most complex wounds are treated 38. We also note that prescribing data will not include data on those standard dressings that are kept as stock.…”

First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence

“…Prevalence is projected to increase due to an aging population and increasing incidence of obesity, diabetes, and cardiovascular diseases . Wound management is a significant clinical issue and is a growing economic burden across the globe (Weller and Evans, 2014;Kapp and Santamaria, 2015;Norman et al, 2015;Gray et al, 2018;Pacella et al, 2018). According to the latest Global Wound Care Market 2016 report (Orbis Research, 2017), the Wound Care Market accounted a value of $18.22 billion.…”

“…Along with patient preferences, clinical expertise is needed to ensure evidence-based wound care (Weller, 2013;Wieten, 2018). However, evidence-based care is frequently suboptimal (Gray et al, 2018;Pacella et al, 2018). To optimize evidence-based decision making, clinicians are encouraged to assess literature on efficacy and cost-effectiveness of dressing products and eliminate the influence of the dressing production industry (Jones et al, 2017).…”