Treatment of wounds of different aetiologies constitutes a major part of the total health care budget. It is estimated that 1⋅5–2 million people in Europe suffer from acute or chronicwounds. These wounds are managed both in hospitals and in community care. The patients suffering from these wounds report physical, mental and social consequences of their wounds and the care of them. It is often believed that the use of wound dressings per se is the major cost driver in wound management, whereas in fact, nursing time and hospital costs are together responsible for around 80–85% of the total cost. Healing time, frequency of dressing change and complications are three important cost drivers. However, with the use of modern, advanced technology for more rapid wound healing, all these cost drivers can be substantially reduced. A basic understanding of the terminology and principles of Health in relation to wound management might therefore be of interest.
Background of the Study
Wounds have a
variety of causes; some arise from surgical intervention, some are the result
of injury, and others are a consequence of extrinsic factors, such as pressure
or shear, or underlying conditions such as diabetes or vascular disease. They
are often classified as a result of their underlying cause into acute wounds,
such as surgical wounds and burns, and chronic wounds, such as leg ulcers,
diabetic foot ulcers (DFUs) and pressure ulcers. Whatever the cause, wounds
have a substantial but often unrecognised impact on those who suffer from them,
on their careers and on the health care system. In fact, the phenomenon of
wounds has been called the Silent Epidemic (Eming et al.
2011). Living with a wound can have a profound effect on
quality of life. The human cost of wounds manifests itself in, among other
things, pain, distress, social isolation, anxiety, extended hospital stay,
chronic morbidity or even mortality. Many of these issues are preventable.
Furthermore, because of underlying factors such as the age of the patient and
the presence of underlying chronic comorbidities, some wounds do not follow the
normal healing process. These ‘hard-to-heal’
wounds defined as wounds that fail to heal with ‘standard therapy’
in an orderly and timely manner cause further deterioration in quality of life
and increase the burden on the health care system over a prolonged period. Sometimes,
it is thought that the financial cost of wound management is just the cost of
the materials used, such as dressings, bandages or topical antiseptics. This is
not the case; most of the cost relates to the use of health care professionals’
time and the cost of staying in hospital, as we will see later. The choice of
materials and treatments, however, can have a major influence on the total cost
millions of traumatic wounds are treated each year in emergency departments in Nigeria.
Wound management is an area of still ongoing research, much of which supports
traditionally performed techniques, but some of which also is still trying to
resolve controversial topics. The basic principles of wound care are simple, as
long as one keeps in mind what the intent of the care being rendered is. First
of all, one must remember that the wound heals itself. If the patient is not
mortally wounded, then the wound will heal all by itself. The physician who
believes that he
the wound heal is deluding himself and does not understand wound healing. So,
what is the big deal and what are the doctors good for if the wound is going to
heal no matter what? In essence, the objective is to restore tissue integrity,
and function, while avoiding infection and morbidity, and minimizing scarring.
To achieve this outcome, a thorough understanding of wounds is necessary (Isaac,
Clinicians who treat patients with wounds need
access to the resources that will enable them to deliver the best and most
appropriate treatments. With economic constraints on healthcare budgets, in
addition to challenges to prove efficacy, budget holders and payers are
increasingly asking for financial justification for the provision of treatment.
They therefore need to know how to provide such justification to ensure
continued provision of appropriate wound management services, including the
implementation of service improvements and new technologies.