- Factors that affect chronic wounds are unique to each individual.
- Treating the whole person acknowledges the intimate relationship bodily systems have on each other.
- Managing multiple chronic conditions is a part of everyday life for at least 40% of U.S. adults.
Chronic non-healing wounds are a silent epidemic. The U.S. national cost of managing chronic patient wounds is estimated to be a staggering $96.8 billion each year. The total Canadian healthcare costs of one type of foot ulcer – diabetic foot ulcers – was $547 million in 2011. The average ulcer cost $21,371. Yet if it became a chronic wound the cost could skyrocket to $52,360 for the individual. While the prevalence of non-healing wounds is comparable to heart failure, wound care physicians are playing a high-stakes game in a set of conditions that are largely unrecognized in the media and the general public.
Factors that affect chronic wounds are unique to each individual. Treatment of chronic wounds is also typically complex rather than a quick fix. One of the major hurdles to wound care has been a lack of effective therapies.
For instance, patients are often transported back and forth to a wound care clinic on a daily basis for hyperbaric oxygen therapy (HBOT). Yet, while this treatment is approved by Medicare for 15 diagnoses, none are for chronic, non-healing wounds. Patients undergoing HBOT breathe 100% oxygen under pressure, with the intent of driving oxygen deep into the tissue to kill infections and speed healing. Medicare does cover this for diabetic wounds, but only when they are classified as Wagner grade III or higher, and the person “has failed an adequate course of standard wound therapy.” In Canada, HBOT is approved for diabetic foot ulcers and skin grafts and flaps that are not healing quickly.
Despite the treatment being used in patients with chronic wounds, the data does not consistently support the treatment. In an early review of the literature there was a lack of evidence showing HBOT’s effectiveness with diabetic foot wounds. A second analysis of 6,259 people with foot ulcers showed it did not improve wound healing, nor did it reduce the likelihood of an amputation. In a third study, HBOT treatment also did not appear to reduce the need for extended wound care or amputation.
Most patients with chronic non-healing wounds are often found in post-acute care (PAC) settings, where chronic conditions such as diabetes and vascular disease have weakened an individual’s immune system and complicated the healing process. When wounds are not properly treated, they can lead to recurrent hospitalizations, amputation, and even death.
Stephanie Newsom, MD, is a wound physician. Newsom says, “To win the war on this epidemic, leading PAC communities are delivering programs that customize interventions to each patient’s needs.”
Positive Outcomes Require Treating the Whole Person
The wound care perspective posits that, in order to treat an individual condition, it is necessary to have an understanding of the whole person, and to make recommendations that affect several bodily systems. This, in turn, increases the potential for successful outcomes, especially in wound care, since chronic wounds are usually affected by several systems and habits. These systems and habits primarily include the cardiovascular and pulmonary systems, diet, nutrition, and exercise. Newsom explains further:
“Whatever the wound—from burns and rashes to pressure sores and diabetic ulcers—our goal is to create a patient-centered environment for wound healing. Along with minimizing pain and reducing the risk of infection, we offer each patient straightforward education on how they can expedite their own healing process. Slow-healing wounds can pose many psychological hazards for patients, from anxiety and depression to shame and grief. Such distress can further disrupt the immune system and impair the healing process.”
Treating the whole person acknowledges the intimate relationship bodily systems have on each other. For example, as Newsom acknowledges, stress can severely impact the immune system, which can, in turn, impact wound healing. Both physiological and psychological stress have a substantial and relevant impact on wound repair, and each can indirectly modulate the process.
In addition, specific challenges and stressors come from chronic health conditions, which, as it turns out, affect 60% of all adults in the U.S. and 44% of adults over 20 in Canada have at least one. The percentage climbs even higher for older adults. And if that wasn’t enough, managing multiple chronic conditions is a part of everyday life for at least 40% of U.S. adults.
The Challenge with Chronic Health Conditions
While many of these chronic health conditions are affected by lifestyle choices such as smoking, alcohol use, nutrition, and exercise, the number of individuals with these chronic diseases would not be so high if lifestyle changes were easily accommodated. Thus, it is important for wound care specialists to acknowledge the challenge patients have in making changes that ultimately affect their own wound healing.
For this reason, a multidisciplinary team approach to wound care is the best option for any practice. Patients have access to nutritional counseling, psychological counseling, physical therapy, certified wound care nurses, and wound care physician specialists to guide and support their decisions. Often, patients will require assistance in making lifestyle choices that ultimately have a positive effect on healing.
Living within a PAC facility also helps patients address some of the top challenges in managing chronic health conditions. These include managing medications, taking them appropriately, and staying motivated to adjust life-long habits, to name a few.
As the baby boomer population ages, the magnitude of this challenge is also increasing. The major cost implications of handling multiple conditions are considerable. With the assistance of a multidisciplinary team, many in a U.S. PAC who are treated by a wound care team can achieve successful wound closure. A team approach to care encompasses each of the healthcare professionals in a single facility, as Newsom explains:
“From clinicians to nutritionists and physical therapists, all are involved in the healing process—following a holistic, highly personalized care plan for every chronic wound. Certified nursing assistants (CNAs) are at the front line of wound care. They have frequent contact with patients, assisting in activities of daily living and serving as gatherers of vital information about each patient’s condition. If a patient develops a new wound or if an existing wound worsens, the CNA is the first to sound the alarm and spur the care team into critical action.”
Transforming Care Through Advanced Training and Collaboration
As has been demonstrated, a physician-led wound care team garners improved patient care outcomes, lower recurrent hospitalizations, and lower costs. To that end, wound care certification is ideal.
As Newsom notes, “While certification isn’t a prerequisite for working in wound care, it reflects a commitment to continuous professional development. It also boosts a patient’s confidence in the care they’re receiving.”
“With a team-based approach, PAC leaders … are delivering healing treatments, giving patients hope, and providing them with the best care possible. The result? An enhanced quality of life today—and an improved health forecast for tomorrow.”