Shortly after the first Covid-19 cases were identified in the UK, many outpatient clinics were temporarily closed or scaled back to help stop the spread of the virus. This sudden and significant change to healthcare delivery caused telemedicine consultations to become the typical route for patients requiring non-urgent care.
In wound clinics – where patients are typically above the age of 70 and are therefore considered more at-risk of developing complications with Covid-19 – minimising the spread of the virus was particularly crucial. Patients suffering with chronic wounds were therefore consulted virtually and advised on how to best treat their condition independently at home, requiring them to become the primary caregivers to themselves.
The burden of wound
Living with chronic wounds has significant negative impacts on the quality of life for patients. Chronic wounds can be extremely painful and impede a patient’s ability to walk and sleep at night. In some cases, the wound may itch, puss and release an unpleasant smell, which can cause distress, discomfort and embarrassment.
This ongoing pain combined with a lack of mobility and sleep can lead to deteriorated mental health and further physical consequences, such as involuntary weight loss. Hard to heal wounds are also at risk of infection which, if left untreated, can lead to septicaemia (blood poisoning) and the potential for limb amputation.
Venous leg ulcers (VLU), the most prevalent type of leg ulcer, account for up to 80 percent of all cases and affect approximately one in 500 people in the UK. Prevalence dramatically increases with age – roughly two percent of people over the age of 80 suffer with VLU. As our population continues to age and comorbidities associated with wounds increase (such as obesity and diabetes), chronic wounds are likely to become a greater threat to healthcare systems.
Funding chronic wound care
Chronic wounds have long been associated with significant healthcare costs, both to the healthcare systems and the patients. Annual treatment of chronic wounds costs the NHS approximately £5.3 billion and the US more than $28 billion.
These costs are relative to the intensive therapy and regular consultation required throughout the treatment of wounds. Wounds must be cleaned and dressed by medical staff, and then redressed and monitored over time to examine progress. Some wounds never heal at all, and these require regular hospital visits, consuming large portions of patients’ time and money. Costs can be further exacerbated by patient adherence and concordance to prescribed compression therapy, extending the cost and time it can take to heal an ulcer.
Modernising wound care with telehealth
Incorporating telehealth into wound care delivery has the potential to significantly reduce these medical and financial burdens. In wound care, asynchronous telehealth involves taking photographs of the wound and uploading them into an electronic medical record, allowing professionals to monitor its progression over time. Further consultation can then be recommended. Already, this makes wound consultation more accessible for patients and would reduce the number of unnecessary hospital trips.
Real-time telehealth involves live video calling allowing patients to communicate directly with a medical professional from their homes. This reduces the need for nurses and patients to travel and makes consultations quicker, cheaper, more convenient, and accessible.
Telehealth solutions could remain ingrained in wound care far beyond the aftermath of Covid-19. However, ensuring these changes in healthcare delivery are successful requires access to the right tools, such as video calling and subsequent Wi-Fi/cellular connectivity, and medical technology devices. Crucially, it relies on a patient’s ability to manage their own medicine to much higher degrees than had previously been the case.
Technology is not limitless
Wound patients are recommended to maintain a healthy diet and move regularly to promote blood flow; however, for elderly patients with mobility issues this is not always possible. During Covid-19, many patients were also tasked with cleaning and dressing their own wounds – something which requires a level of medical knowledge and skill that should be taught by a professional.
Although remote consultations can be effective, they lack the ability to practically demonstrate to patients how to correctly bandage a wound. Even where patients build the knowledge base to dress a wound independently, it is possible that not enough pressure will be applied to best support recovery. For VLU, this can have significant negative impacts on the healing process.
Making self-management simpler
MedTech devices are aiding the effort to make wound care more self-manageable: wearable devices that are simple to use and self-administer in a home setting allow patients to take charge of their own recovery. MedTech offers solutions to issues with patient independence by speeding up recovery times, enhancing comfort during recovery and increasing mobility.
Clinical data has proven that increased blood flow to the wound surface, to enhance oxygen and nutrient delivery, can significantly help to heal leg ulcers – with wounds closing in a matter of weeks, as opposed to months or not at all. Therefore, a device that promotes blood flow could help with the closure of hard to heal wounds. Such devices need to be designed so they can be easily self-applied with clear instructions for use. If achieved, MedTech devices of this nature could significantly enhance the care pathway and improve recovery in the home setting.
Remaining personal
Telehealth – if executed properly – has the potential to significantly improve patient outcomes in wound care. Telemedicine is more than doctor consultations by phone or video; it means considering the entire home healing process and ensuring patients have the ability, knowledge and resources to be their own healthcare worker. Combining remote care with MedTech equips patients with the relevant tools to take control of their own recovery with the support of wound specialists when required.
This could have lasting benefits for patients – reducing costs and time spent travelling, while speeding up recovery. It also gives wound specialists more opportunities to advise, diagnose and virtually treat more patients than would otherwise be possible face-to-face. If patients can recover more quickly at home, and healthcare systems can spend less time, resources and money on patients hospitalised with wounds, a large proportion of the significant costs associated with wound care can be reduced.
About the author
Bernard Ross is CEO and founder of Sky Medical Technology (Sky). Sky creates world-leading medical devices that saves lives while saving healthcare systems money. Sky’s biomedical devices use its proprietary bio-electronic nerve stimulation technology – OnPulse™ – clinically proven to increase blood circulation in the deep veins of the calf. The result is the company’s multi-award-winning device, the geko™ – a wristwatch-sized wearable applied to the knee delivering painless electrical impulses to stimulate blood flow, without the patient having to move.
References
- National Health Service. (2019) Symptoms of venous leg ulcers. Available at: https://www.nhs.uk/conditions/leg-ulcer/symptoms/.
- DeSanti L. (2000). Involuntary weight loss and the nonhealing wound. Advances in skin & wound care, 13(1 Suppl), 11–20. Available at: https://pubmed.ncbi.nlm.nih.gov/11061713/
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Chronic wounds: Overview. 2006 Oct 17 [Updated 2018 Jun 14]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK326431/
- National Health Service. (2019) Overview: venous leg ulcers. Available at: https://www.nhs.uk/conditions/leg-ulcer/
- Guest JF, Ayoub N, McIlwraith T et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open 2015; 5(12):e009283. Available at: https://www.magonlinelibrary.com/doi/epub/10.12968/jowc.2017.26.6.292
- Carver T. New study demonstrates the economic costs; medicare policy implications of chronic wounds. Available at: https://www.apwca.org/news/53104492017
- Flanagan, M. (2005). Barriers to the implementation of best practice in wound care. Wounds UK. Available at: https://www.wounds-uk.com/journals/issue/4/article-details/barriers-to-the-implementation-of-best-practice-in-wound-care-1
- Kostovich, C. T., Etingen, B., Wirth, M., Patrianakos, J., Kartje, R., Baharestani, M., & Weaver, F. M. (2022). Outcomes of Telehealth for Wound Care: A Scoping Review. Advances in skin & wound care, 10.1097/01.ASW.0000821916.26355.fa. Available at: https://doi.org/10.1097/01.ASW.0000821916.26355.fa
- Jones, NJ., Ivins N., Ebdon, V., Hagelstein, S., Harding, KG. Neuromuscular electrostimulation on lower limb wounds. British Journal of Nursing 2018 27:20, S16-S21. Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2018.27.Sup20.S16
