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

Abstract

Background: Complex 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.

Objectives: To 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.

Design: A multiservice cross-sectional survey.

Setting: This survey spanned eight community services within five Northern England NHS Trusts.

Results: The 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.

Conclusions: Marked 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.

Keywords: evidence based practice; health services research; healthcare quality; healthcare value; patient-centred care; prevalence survey; wound management.

Figure 1

Proportion of complex wounds for which primary dressing contained antimicrobials: the other antimicrobial dressing group maps to the same section of the British National Formulary and includes dressings such as polyhexanide polyhexamethylene biguanide (bars represent included community services). Number of patients per community service ranged from 172 to 655.

Figure 2

Highest level of compression used for patients with VLUs selected as most severe wound (bars represent included community services). Number of patients per community service ranged from 14 to 151. VLU, venous leg ulcer.

Figure 3

Proportion of patients using pressure-relieving mattresses or cushions (bars represent included community services). Number of patients per community service ranged from 10 to 63.