Improving wound care outcomes

Venous leg ulcers (VLCs) — a chronic sore on the leg or ankle — that can take a long time to heal can reportedly cost patients over 60 around $27.5 million in out-of-pocket costs for wound care consumables each year. VLCs are the most common chronic wounds seen in primary care settings. Others include: diabetic foot ulcers, pressure injuries and arterial insufficiency ulcers.

Chronic wounds affect more than 420,000 Australians, with each patient spending over $4000 on out-of-pocket costs, according to Wounds Australia, a not-for-profit body for wound prevention and management. They cost the country’s health and aged care systems over $3 billion.

“Australia’s healthcare professionals are among the best in the world, and we know they work hard to ensure the best possible health outcomes for their patients. But a significant percentage of our highly skilled health professionals are largely unaware of the hidden epidemic of chronic wounds, and successive governments have failed to effectively tackle the issue,” said Hayley Ryan, Chair, Wounds Australia. Ryan is also an adjunct fellow at the University of Technology, Sydney and an experienced nurse with a passion for healing wounds.

A national approach

While anyone can suffer from a chronic wound, people over 65 are said to be the most vulnerable due to aging-related complications, according to Wounds Australia. The industry body has long been advocating for a national approach to the prevention, management and healing of wounds for many years and in 2021 delivered an 11-point plan to the Morrison government that proposed significant reforms to improve the way to raise awareness, prevent, diagnose, treat and heal wounds in Australia.

Wounds Australia is now “committed to working with the new Labor government to drive national wound care policy based on the solutions presented in our plan and to improve the lives of those Australians currently suffering from this debilitating condition”, according to Ryan.

The lack of a national wound care framework and lack of Medicare itemisation for wound diagnosis, treatment and healing means that patients — often those from communities who can least afford it — foot the bill for their wound care, she said.

Wounds, Ryan said, are a global problem with many countries facing similar challenges to the ones we are confronted with here in Australia. There is a valuable opportunity for Australia to lead the world in this area.

“What is really important both here and internationally is driving research and action and ensuring people suffering from wounds get the support and treatment they need to improve their lives and ultimately heal their wounds,” she said.

Supporting primary care professionals

“It’s a shocking fact that doctors and nurses in Australia do not receive dedicated wound care education as part of their university studies,” Ryan said.

Due to lack of dedicated education, they are often underprepared to effectively diagnose and treat wounds, she said. The result is that wounds fail to properly heal, requiring ongoing treatment and support and pushing patients into the hospital system unnecessarily.

“We know that Australia’s health system is under pressure; taking chronic wounds patients out of the equation through early intervention and prevention, as well as ensuring health professionals working in a primary setting are equipped and supported to diagnose and treat wounds, would be an effective and powerful way to relieve some of that pressure.”

Challenges ahead

Proper wound diagnosis is the first major challenge that all clinicians face, according to Ryan. “It is generally accepted that a wound is considered acute if it moves through the stages of wound healing within four weeks. As a wound moves through the stages of healing, the challenge faced by both the clinician and the patient is ensuring ‘nothing goes wrong’ that could see the acute wound develop into a chronic one.

“As clinicians, it’s critical we know how other issues such as diabetes, venous insufficiency and mental health can negatively impact on an acute wound. Also critical is that we have the education, training and skills to work with our patients to successfully treat and heal acute wounds and ultimately empower our patients to prevent reoccurrence or new wounds developing.”

The mental health impacts

“In my own professional practice, I see strong causal links between chronic wounds and mental health conditions such as depression and anxiety, so diagnosing and treating wounds before they become a problem seems like an obvious way to improve the quality of life of elderly Australians,” Ryan said.

“The intersection between wound care and mental health is a fascinating area and it’s one we’ll be exploring at our conference in September, with Baylor College of Medicine’s Professor Bijan Najafi sharing his research into the impact of frailty on wound care and Associate Professor Michael Woodward of Victoria’s Austin Health looking at the relationship between dementia and mental health and wounds,” she said.

From 14–17 September 2022, leading industry experts and delegates from around the world are coming together to explore the current developments, innovations, practice and research that unite and heal at the Wounds Australia 2022 Conference Time to Heal, Time to Unite, Time to Innovate. To be held at the ICC, Sydney, the conference will offer industry professionals the opportunity to explore the history of wound care, investigate current practice, learn about progress made so far and explore opportunities for future innovations.

Support for aged care

Offering hardworking aged care professionals specialised education and training in wound identification, diagnosis and treatment is crucial, Ryan said.

“What will make the biggest impact is supporting those working in aged care, our aging Australians and their families to be wound aware, to take preventative action to stop wounds before they start and to empower them to take immediate action at the first sign of a wound developing.”

Unfortunately, aged care is also an area where wounds just don’t appear to be a top priority, Ryan said.

“With only four out of 168 recommendations from the Aged Care Royal Commission mentioning wound care, it is clear there is a lack of understanding and awareness of the health, economic, social and personal impacts wounds have on this vulnerable group of people.

Equitable access

Improved healing, Ryan said, comes back to three basic principles: the right diagnosis, the right treatment, at the right time.

“We can achieve this by ensuring equitable access to qualified clinicians, treatment and the correct healing products. What Wounds Australia is pursuing with the government is the establishment and funding of a national wound services and support scheme. The scheme we are proposing is similar to the support provided to other major health priorities such as diabetes.”

Ensuring those who are most at risk have access to affordable wound care will be a huge step forward, according to Ryan. Getting this right is a major step towards reducing the risk of future infections and minimising the negative impacts of wounds on individuals, she said.