Tissue viability
Wound care in the wake of the pandemic
Bernard Ross reports on a survey of experts and patients which sought views on the effects of the COVID-19 pandemic on the delivery of tissue viability care. The survey also looked at the causes of non-adherence to treatments, the role of telemedicine and innovation, the emotional impact of living with unhealed leg venous ulcers, and the current state of wound care resources.
Successful healthcare delivery relies on a patient’s ability to adhere to their prescribed treatment. Despite the fast pace of healthcare innovation over the last century, many care pathways remain afflicted by patient non- adherence – particularly for chronic diseases. Adherence to medication for chronic conditions is as low as 50 percent in high-income countries, and lower in poorer areas. Non-adherence contributes to at least 100,000 preventable deaths and $100 billion in preventable medical costs per year in the US alone.1 Wound care is no exception; many patients living with chronic wounds, such as venous leg ulcers (VLUs), struggle to adhere to treatment. Hard-to-heal and recurring wounds cause a significant negative impact on a patient’s quality of life and contribute to billions in healthcare costs. Leg ulcers alone cost the NHS almost £2 billion to treat every year.2
Tackling
adherence to wound care can improve patient outcomes, relieve pressures on healthcare systems and reduce treatment costs.
A silent epidemic VLUs are the most prevalent type of leg ulcer, making up approximately 90 percent of all cases and affecting one in 500 adults in the UK.3
Although VLUs typically heal within three
to four months, some take years while others never heal at all. Recurrence is also common, affecting up to 70 percent of patients, leaving many suffering with VLUs on an ongoing basis, requiring frequent care from wound specialists.4 It is estimated that adherence to VLU
standard of care ranges between 12 and 52 percent, indicating that many patients are unable to reap the benefits of VLU treatment.5
Wound care and reasons for non-adherence Standard of care for VLU treatment recommends compression therapy, typically involving medically prescribed compression
bandaging or stockings applied by a clinically trained wound specialist. Compression therapy reduces vein distension activating the calf muscles to pump blood back to the heart and reduce oedema. Compression bandaging comes in various forms, including two- and four-layer, hosiery and wraps and will depend on what is required for optimal healing as well as the patients’ preferences for comfort. However, there have been few improvements
over the last 30 years in the levels of adherence to wound care. This was significantly exacerbated by COVID-19 where wound clinics were closed and scaled back to stop the spread of the virus, leaving patients to manage their ulcers independently at home.
Identifying the causes There are many factors that can affect adherence making the management of healing extremely difficult. Weller et al (2021)6
the most common contributors to non- adherence into the following groups: l Knowledge domain (e.g. lack of understanding of the management plan and rationale behind treatment)
l Social influences (e.g. compression-related body image issues)
l Beliefs about consequences (e.g. lack of understanding of the consequences of not wearing compression)
l Emotions (e.g. feeling overwhelmed due to a lack of progress with healing)
l Environmental context and resources (e.g. hot weather causing discomfort with compression)
l Behavioural regulation (e.g. lack of patience and persistence)
categorise
l Memory, attention, and decision making (e.g. cognitive issues limiting the ability to remember or understand self-care instructions)
August 2023 I
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