Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes

Abstract

Objectives: The aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK's National Health Service (NHS), and the associated costs of patient management.

Methods: This was a retrospective cohort analysis of the records of 209 patients identified within a randomly selected population of 6000 patients with any type of wound obtained from The Health Improvement Network (THIN) Database, who developed a PU in the community and excluded hospital-acquired PUs. Patients' characteristics, wound-related health outcomes and healthcare resource use were quantified over 12 months from initial presentation, and the corresponding total NHS cost of patient management was estimated at 2015/2016 prices.

Results: 50% of all the PUs healed within 12 months from initial presentation, but this varied between 100% for category 1 ulcers and 21% for category 4 ulcers. The mean time to healing ranged from 1.0 month for a category 1 ulcer to 8 months for a category 3/4 ulcer and 10 months for an unstageable ulcer. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 53% of all the ulcers may have been clinically infected at the time of presentation, and 35% of patients subsequently developed a putative wound infection a mean 4.7 months after initial presentation. The mean NHS cost of wound care over 12 months ranged from £1400 for a category 1 ulcer to >£8500 for the other categories of ulcer. Additionally, the cost of managing an unhealed ulcer was 2.4 times more than that of managing a healed ulcer (mean of £5140 vs £12 300 per ulcer).

Conclusion: This study provides important insights into a number of aspects of PU management in clinical practice in the community that have been difficult to ascertain from other studies, and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.

Keywords: UK; burden; cost; pressure ulcers; wounds.

Figure 1

Patients who received multiple dressings.

Figure 2

Kaplan-Meier time to healing analysis. The healing distribution between the five groups was significantly different (log rank (Mantel-Cox): p<0.0001). PU, pressure ulcer.

Figure 3

Wound healing stratified by body mass index (BMI, kg/m²).

Figure 4

Monthly cost of wound care. NHS, National Health Service; PU, pressure ulcer.

Figure 5

Kaplan-Meier time to healing analysis for patients who did and did not receive antimicrobial dressings. The healing distribution between the two groups was significantly different (log rank (Mantel-Cox): p=0.006).

Figure 6

Kaplan-Meier time to healing analysis for patients who did and did not receive prescribed systemic anti-infectives. The healing distribution between the two groups was significantly different (log rank (Mantel-Cox): p<0.001).

Figure 7

Kaplan-Meier time to healing analysis for patients who did and did not receive an antimicrobial dressing and/or prescribed systemic anti-infectives. The healing distribution between the two groups was significantly different (log rank (Mantel-Cox): p<0.001).