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Healing the wound care crisis

Better management of wound care could generate significant savings as budgets come under increasing pressure. By Aileen Macalintal

Who would think caring for wounds could cost billions? An estimated 433,000 Australians deal with acute and chronic wounds annually, costing the health system $2.6 billion, according to a new organisation for wound-care tools, systems and technologies.

The Wound Management Innovation Cooperative Research Centre, established at the University of Queensland, contends that wound management is one of the 21st century's major clinical challenges as the area receives little attention despite the need to improve approaches in diagnosis, treatment, management and prevention of wounds.

Research in this field, such as studies in wound and tissue repair, is yet to adopt modern biotechnology and evidence-based clinical practice, according to the centre.

In Australia, there are 4000 amputations due to a non-healing diabetic wound per year; more than 50 per cent of community nursing care involves wound care; a quarter of aged-care home residents have a wound; the second most frequently billed item in general practice is wound care; 400,000 Australians suffer from wounds at any given time; and wounds affect up to 10 per cent of those over 80 in Australia.

Nurse practitioner Michelle Gibb, who heads QUT's wound healing community outreach service, is alarmed by these statistics.

She said that with an ageing population, the problem of wounds is likely to rise, so it is essential that nurses identify those individuals at risk, know what interventions could be implemented to prevent skin breakdown and identify strategies on wound management.

Wounded health system

Gibb said research at QUT found that up to 70 per cent of patients with a venous leg ulcer have never been assessed to determine the aetiology (cause). Those patients have never had best-practice wound treatment - compression therapy - due to the simple reason that many are unaware of the availability of treatment, while others do not know where to seek help.

"Unfortunately, current Medicare subsidy arrangements do not encourage best-practice care.

Australia does not fully subsidise the essential costs of care outside of the acute hospital system," Gibb said.

This leaves major costs - including the cost of compression bandaging and stockings - with patients, who have to shoulder major costs. Many pensioners cannot afford the treatment.

"The result is a false economy where wounds do not heal, patients suffer and the health system is burdened with substantial avoidable costs such as repeat visits by community nurses and general practitioners and repeat admissions to hospital for recurring complications," Gibb said.

All these add to the pressure on public hospitals, she said.

Leading the world

Every day, new dressings, diagnostic tools and therapies are designed to help improve outcomes for wound sufferers. Gibb admits it can be overwhelming keeping up with the developments in the area, yet there is an urgent need for more research.

"Fortunately in Australia, we have become world leaders in wound-healing research and are now working collaboratively across the nation to raise awareness and change practices and outcomes for patients," she said.

WMICRC involves 21 partner organisations from around Australia. It has a $110 million research project focusing on the development of cost-effective and practical wound therapies, as well as diagnostics and clinical interventions.

In the coming years, a number of developments are expected to emerge from this project, helping to change the lives of those suffering from wounds and the most exciting thing, according to Gibb, "is that nurses will be one of the key people to implement the outcomes of this research".

When caring for people with chronic wounds, nurses and other health professionals are being called on to develop partnerships and collaborative working relationships.

"No one profession working in isolation has the expertise to respond adequately to the increasing complexity of patients' needs," Gibb said.

Seminars and research

Through seminars and research, strategies and treatments are continuously developed to address the pain and suffering from different kinds of wounds.

The social and economic impacts of diabetic foot ulcers, for instance, have been studied. This research was presented when the Australian embassy in Jakarta hosted a seminar on wound management innovations last February.

Professors Zee Upton and Helen Edwards, who established the new centre, tackled treatment and management of wounds and their significant cost to patients, the economy and the wider community.

Edwards is from QUT's School of Nursing and Midwifery, while Upton is the leader of the Tissue Repair and Regeneration Program at QUT's Institute of Health and Biomedical Innovation.

Learning more

Registered and enrolled nurses who want to specialise in wound management need to have an in-depth look at the latest evidence-based, cost-effective practices.

"It is essential that all health professionals increase their knowledge of wound care to provide the best management for their patients and work in a collaborative team together for the best outcomes," said professor Geoff Sussman, from the faculty of medical and health science at the University of Auckland and faculty of medicine at Monash University.

Sussman, who has been involved in this area for almost 40 years as a clinician, researcher and educator, has been teaching in Ausmed Education Pty Ltd's program, Wound Care Management - The Next Step, a two-day course designed for nurses who have knowledge of wound care.

The course includes a bandaging workshop and lectures on the impact of prescribed drugs on wound healing, caring for the feet of people with diabetes, and non-clinical complex wound issues.
Ausmed CEO, Cynthea Wellings, said feedback about the program had been great. "We have been running this program for a considerable period of time now and it is consistently highly evaluated by those who attend.

"The presenters are proficient in the area of wound care and continually update their knowledge to keep abreast of new evidence as it emerges and its implications for practice. They are also great lecturers who can really get their message across.

"This program has been run by the same educators for several years and we find that many participants seem to return to keep themselves up-to-date," Wellings said.

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