Health economic burden that wounds impose on the National Health Service in the UK

OBJECTIVE: To estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs. METHODS: This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients' characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices. RESULTS: Patients' mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p<0.001) and diabetes (OR 0.65; p<0.001) were independent risk factors for non-healing. There were an estimated 2.2 million wounds managed by the NHS in 2012/2013. Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits. The annual NHS cost of managing these wounds and associated comorbidities was pound5.3 billion. This was reduced to between pound5.1 and pound4.5 billion after adjusting for comorbidities. CONCLUSIONS: Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity ( pound5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.Ye

The importance of detecting lower limb ischaemia

NoLower-limb ischaemia is a frequently unrecognised consequence of arterial disease. It not only compromises wound healing, but is a harbinger of more generalised cardiovascular disease. Detection and appropriate management will not only improve wound healing, but also reduce patient morbidity and mortality by allowing proactive risk modification. Ischaemia is an important factor in skin vulnerability and a major cause of delayed wound healing. Recognition of ischaemia is, therefore, important if wound prevention strategies are to be effective and wound healing optimised. The detection of ischaemia can, however, be difficult and requires a careful evaluation of patient symptoms and clinical signs [Box 1]. It is also important to carry out a detailed physical examination, often supported by investigations, such as Doppler examination of peripheral pulses, ankle blood pressure measurements and the calculation of the ankle brachial pressure index (ABPI)

Diabetic foot ulcer or pressure ulcer? That is the question

NoThe establishment of a correct diagnosis links care to established guidelines and underpins all subsequent therapeutic activity. Problems can arise when definitions of disease overlap, as is the case with diabetic foot ulceration and pressure ulcers on the foot occurring in people with diabetes. In such cases, clinicians must ensure that patients receive a care bundle that recognises both the wound causation (pressure and shear) and the underlying pathology (diabetic neuropathy, potential foot architecture disruption and ischaemia). All patients with diabetes that have foot ulceration, irrespective of wound aetiology should, therefore, be seen by the multidisciplinary diabetic foot team. Care can then be optimised to include appropriate assessments, including assessment of peripheral perfusion, correct offloading, appropriate diabetic management, and general foot and skin care

Clinical care delivery implications of the "Burden of Wounds" study

NoThe recently published ‘Burden of Wounds’ study (Guest et al, 2015a) not only highlighted the cost of delivering wound care in the UK but also revealed a number of shortcomings in the method of care delivery, many of which could potentially have adversely affected patient outcome. This paper looks more closely at some of the clinical and service issues raised by the published data from the study and combines this with observations made by the research team when reviewing the patient records to generate a number of recommendations for improvements in staff engagement, documentation, clinical management and service delivery. By implementing these recommendations variations in care standards should be reduced, delayed and non- healing be recognised earlier and as a result cost savings generated

Defining, assessing and managing cavity wounds

NoThis paper provides an overview of cavity wounds, focusing on the definition, assessment and management of a common clinical problem in wound care. The term cavity wound is applied widely to a diverse range of acute and chronic wound types and, although each type requires a specific wound management approach reflecting the causation, the overall principles of cavity wound assessment and management remain the same. The extent of a cavity wounds can be difficult to visualise and such wounds require precise documentation and wound measurement if progress is to be accurately monitored and patient safety maintained

Wound dressings: principles and practice

NoKnowledge of clinically and cost-effective wound management is an obvious requirement for surgeons, yet wound care education rarely features within the medical curriculum. As a result surgical trainees are often poorly placed to join in multidisciplinary wound management and may feel threatened when asked to manage wound complications. A vast range of dressing products exists yet robust evidence of the function and effectiveness of individual products is often lacking. An understanding of wound pathophysiology, a defined treatment goal and regular wound assessment combined with knowledge of basic wound dressing categories will provide guidance on product selection for different clinical situations and wound types

Compression therapy for venous ulcers.

International consensus on compression therapy has been reached. Kathryn Vowden and Professor Peter Vowden discuss the guidance. </jats:p

Are we fully implementing guidelines and working within a multidisciplinary team when managing venous leg ulceration?

NoHigh compression therapy, whether with bandage systems or hosiery, is the accepted treatment of lower limb venous ulceration. Compression has not only been shown to improve healing, it has been demonstrated to reduce oedema and improve tissue oxygen levels (Stacey et al, 1990), reversing some of the changes associated with chronic venous insufficiency (Vandongen and Stacey, 2000). The introduction of multilayer high compression bandage systems in the late 1980s, and subsequent improvements in bandage textiles and design, have undoubtedly improved outcomes for many patients. However, compression alone does not address the underlying pathology of venous ulceration, chronic venous insufficiency (CVI), and without treatment CVI continues to cause skin damage and increases the risk of recurrent ulceration. In 1999, Nelzen emphasised that compression treatment has been used since the days of Hippocrates and yet has not solved the problem of leg ulceration (Nelzen, 1999)

The economic impact of hard-to-heal wounds: promoting practice change to address passivity in wound management

NoAs the prevalence and incidence of wounds are predicted to increase due to an ageing population with increasing comorbidities, reducing the burden of wounds by optimising healing is seen as a key factor in lowering wound care costs. Inappropriate or delayed treatment adversely affects the time to wound healing, impacting quality of life, and increasing the burden on patients, their families and carers, society and the health economy. Identifying non-healing wounds is vital to cost reduction. Failure to recognise wounds not progressing towards healing increases the subsequent risk of non-healing and places the patient at unnecessary increased risk of wound complications