After weeks, and sometimes even months, some wounds simply do not heal. These wounds, often referred to as chronic wounds, require a little bit different care than the average wound. Ultimately, the medical practice of wound care can lower patient risk and offer better patient outcomes, and it’s an effective tool for any modern physician.
In order to be considered a chronic non-healing wound, a wound must not have started to heal within 2 weeks, and must not have completely healed within 6 weeks.
Common reasons for chronic wounds include pressure sores, radiation treatments, and foot ulcers, often due to poor venous flow and diabetes. However, the vast majority of chronic wounds are actually from chronic leg ulcers.
A 2018 retrospective review of Medicare records found 8.2 million people had suffered wounds with or without infections. The combination of a growing aging population with higher rates of chronic disease, including cardiovascular disease, obesity, and Type 2 diabetes, increases the risk for tough-to-treat wounds which results in a substantial social and economic challenge.
Growth of Wound Care Clinics
The emergence and subsequent growth of wound care clinics is a reflection of the rising incidence of chronic wounds and the cost to healthcare systems. Wound care clinics can be found as freestanding entities or incorporated into large hospital-based programs.
The wound clinic is an example of a steady trend in specialized medicine that was popularized in the care of other chronic diseases, such as cardiovascular disease, diabetes, and cancer. A growing need to treat chronic wounds has resulted in the production of advanced wound care products designed to treat burns, chronic wounds, and complex trauma or surgical wounds.
Yet, despite operating in a competitive arena, the market value has reached $2.46 billion and is expected to grow at a rate of 4.2% annually until 2026. This represents the sale of dressing material only and does not include negative pressure wound devices, biologics, ultrasound, electromagnetic therapy, or hyperbaric oxygen therapy. In other words, $2.46 billion is a mere fraction of the amount of money spent on healthcare costs on patients who have chronic wounds.
Effective Onsite Treatment Is the Optimal Option for Patients
A wound care team includes physicians who evaluate a given wound and prescribe treatment, physical therapists who help a patient to stay mobile, and certified wound care nurses who can effectively clean and dress the wound and teach people how to take care of it at home.
Older adults have a higher likelihood of having hard-to-heal wounds than young people. They are also more likely to be treated in a skilled nursing facility. By utilizing certified wound care nurses within the organization, as well as physicians who can recommend treatment on a weekly basis, effective onsite treatment protocols help effectively reduce healthcare costs without compromising treatment. Multiple types of chronic wounds can be successfully treated using this model, including:
- Venous and arterial leg ulcers
- Pressure ulcers
- Skin/muscle grafts or flaps
- Skin tears or lacerations
- Traumatic wounds
- Sores from radiation therapy
- Postoperative wounds or infections
- Wounds secondary to autoimmune disorders
Treatment options that can improve the potential for healing can all be offered onsite. Treatment is not limited to the wound site, but rather addresses an individual’s health factors that affect wound healing. These factors can include nutrition, vitamin deficiency, blood sugar control, and weight management. Traditional wound care can be effectively managed on-site using debridement, compression, moist dressings, and medications. In addition, some wound care practices such as Vohra Wound Physicians, have developed technologies to improve wound healing and help predict the course of care.
The Case for Onsite Wound Care Teams
A comparison of skilled nursing facility residents with a diagnosis of pressure, Venus, ischemic, and diabetic ulcers was performed to analyze care between those who received traditional treatment and those who received care from a wound management team. There were 372 patients in the intervention group and 311 matched participants in the control group. The intervention group received care and had a lower rate of wound-related hospitalizations. Additionally, the intervention group healed an average of 21 days faster than the control group. Ultimately, the wounds management team saved Medicare $19,229.19 in health care costs.
The onsite care also meant patients were not being transported daily or weekly to a wound care clinic, but rather were treated in their residential facility. As a result, this vulnerable population was not exposed to additional bacterial infections, not uncommon in a hospital setting. Each year, one in 25 patients in the hospital is diagnosed with a hospital-acquired infection (HAI), many of which are caused by antibiotic-resistant bacteria which can lead to sepsis and death.
Is Hyperbaric Oxygen Therapy Effective?
Many patients attending a wound clinic are prescribed hyperbaric oxygen therapy (HBOT). For treatment, patients enter a chamber to breathe 100% oxygen under pressure. This involves daily trips to the wound clinic for treatments, often lasting for weeks. There are 15 diagnoses for which HBOT is covered by Medicare, none of which are chronic non-healing wounds. Diabetic wounds in the lower extremity are covered, but only if the wound is classified as a Wagner grade III or higher, and the person “has failed an adequate course of standard wound therapy.”
Despite regular use of HBOT, data does not consistently support the use of the treatment. one review of the literature found a lack of scientific evidence to clearly support use with diabetic foot wounds and called for larger, adequately-blinded, controlled, and randomized studies. An analysis of 6,259 people with foot ulcers revealed hyperbaric oxygen did not improve the likelihood a wound would heal, nor did it reduce the likelihood of amputation.
A third study compared the outcomes between HBOT and hyperbaric air. Patients were placed in a hyperbaric chamber for 85 minutes daily, five days a week, for eight weeks. At the end of one year, 52% of the patients in the HBOT group had complete healing of the primary ulcer and 29% had complete healing in the placebo group. Thus, HBOT treatment did not appear to reduce the need for amputation, since the intervention group had three major amputations as compared to one in the placebo group.
While wound care clinics initially filled a need, in the current healthcare market onsite standardized and coordinated wound care by highly skilled physicians and certified wound care nurses has demonstrated the ability to effectively speed wound healing, reduce medical costs, and reduce complications. Today, without relying on HBOT, patients are safely and conveniently treated where they live.
The views and opinions expressed in this blog post are those of the authors and do not necessarily reflect the official policy or position of The Eastern Herald.