Improved wound management at lower cost: a sensible goal for Australia

Abstract

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Keywords: Australia; Chronic wounds; Cost-effectiveness analysis; Leg ulcer; Wound management.

Figure 1

Distribution of chronic wounds in Australian hospitals and residential care settings. Source: Graves et al. 2. Chronic wounds are defined as those that have failed to proceed through an orderly and timely reparative process to produce anatomic and functional integrity or that have proceeded through the repair process without forming a sustained anatomic and functional result 118.

Figure 2

Wound Management Services in Australia. ¹Wounds diagnosed by a health care professional would be managed by a range of community‐based services. These services vary by their knowledge skills and ability to heal chronic wounds. For example, a patient could be seen by his/her general practitioner (GP), not be offered evidence‐based care and bounced around between community care services and GP visits for long periods of time incurring high costs and suffering poor quality of life. ²In addition to GPs, wounds can be treated by medical specialists (on referral) such as dermatologists or vascular surgeons, nurses, allied health professionals and Aboriginal health workers. Treatment can also be provided in specialised hospital‐based outpatient wound clinics (upon referral from medical practitioner). There are also specialist wound clinics led by nurse practitioners and podiatrists (in the community as well as private) 10, 97, 119. In addition, unregulated health care workers have been known to provide wound care in aged care facilities. These services include patient out‐of‐pocket payments for services, products and devices. ³A wound not diagnosed might be self‐managed for some time until the patient seeks care from a range of community‐based services² and might then continue with self‐management. ⁴All chronic wounds, self‐managed or other, are at risk of infection, which could lead to admissions to acute hospitals⁵ and, in some cases, amputation or even mortality⁶. After discharge from hospital, these chronic wounds are again managed by community service providers², and patients may then be re‐admitted to hospital with complications. ⁷Wounds managed by community service providers could be healed after some time and then might recur, incurring further interactions with community‐based services.