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Telemedicine driving smarter healthcare solutions in wound care

15/06/2022

The Journal of mHealth

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. Emergency department attendance fell to 52 percent as fears grew of catching the virus.1 This sudden and significant change to healthcare delivery caused telemedicine consultations to become the typical route for patients requiring non-urgent care, particularly in wound care.

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During Covid-19, patients suffering with chronic wounds were consulted virtually and advised on how to best treat their condition independently at home, requiring patients to become the primary caregivers to themselves. Despite Covid-19 restrictions gradually easing around the world, the move to remote healthcare – sped up by the pandemic – has continued as patients and healthcare professionals enjoy the convenience of remote diagnosis and care.

Measuring change in healthcare

This greater reliance on remote care is the result of a societal change that extends far beyond healthcare alone. People had to quickly adapt to entirely new circumstances when face-to-face interactions were forbidden. For many, this left telecommunication as the only option to keep business – and life – running as usual.

For healthcare systems, the step towards virtual care was vastly accelerated by Covid-19. Telehealth solutions and technological interventions that would have otherwise taken years to implement were rolled out in months. 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.

The burden of wound

Although most chronic wound cases are not considered life threatening, living with chronic wounds has significant negative impacts to the quality of life of patients and those who care for them. Chronic wounds can be extremely painful and impede a patient’s ability to walk, move and sleep at night. In some cases, the wound may itch, puss and release an unpleasant smell, which can cause distress, discomfort and embarrassment for patients.2

This ongoing pain combined with a lack of mobility and sleep can lead to deteriorated mental health and further physical health consequences, such as involuntary weight loss3. Hard to heal wounds are also at risk of infection which, if left untreated, can lead to septicaemia (blood poisoning) and ultimately the potential for limb amputation.4

Chronic wounds are extremely common. Venous leg ulcers, 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.5 This dramatically increases with age – roughly two percent of people over the age of 80 suffer with venous leg ulcers. 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

The burden of wound extends far beyond the physical and mental suffering it causes patients. Chronic wounds have long been associated with significant healthcare costs, both to the healthcare systems and the patients. Treatment of chronic wounds costs the NHS approximately £5.3 billion6 each year and the US more than $28 billion annually. 7

These costs are relative to the intensive treatment and regular consultation and therapy required throughout the treatment of wounds. Wounds must be cleaned and dressed by qualified 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.

A study by Drew et al. found that between 15 and 20 percent of wound costs derive from material costs, such as dressings and medical gloves, while 30-35 percent is spent on nursing time (including travel for community nurses). Patient hospitalisation accounts for more than 50 percent of the overall spend on wound care.8 Quick diagnosis and effective care pathways are even more important in reducing the number of hospitalisations.

These costs can be further exacerbated by patient adherence and concordance to prescribed venous leg ulcer compression therapy, extending the cost and time it can take to heal an ulcer.9 Patients can also frequently be required to travel long distances to access a specialist wound care clinic, spending a substantial amount of money to attend them.

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 can involve taking photographs of the wound and tracking its progression over time.10 These images can then be uploaded into an electronic medical record and monitored by a professional who can recommend further consultation if required. 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 – particularly for patients living in rural areas.

Telehealth solutions could remain deeply ingrained in wound care far beyond the aftermath of Covid-19. Research from BRC predicts that by 2030 the global telemedicine market will be worth more than 459 billion USD, up from 194 billion USD predicted for 2023.11 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

Patient self-management typically involves maintaining a healthy diet, exercising regularly, managing dosages of prescriptions, or monitoring vital signs like weight and blood pressure. For wound patients, exercising to promote blood flow is not always possible, particularly for elderly patients with mobility issues. 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 to achieve optimal recovery.

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 venous leg ulcers, this can have significant negative impacts on the healing process.

The National Institute for Health and Care Excellence (NICE) states that: “the use [of compression bandages] calls for an expert knowledge of the elastic properties of the products and experience in the technique of providing careful graduated compression.” With patient self-management this becomes more troublesome and risks wounds not healing properly or healing more slowly – in some cases doing more harm than good.

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 can be self-administered in a home setting allow patients to reduce the time spent in hospital and 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.

As an example, 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.12 Therefore, a device that promotes blood flow could help with the closure of hard to heal wounds. Such devices need to be simple enough for patients to apply themselves and come with clear and concise instructions for use. If achieved, such devices could significantly enhance the care pathway and improve recovery in the home setting.

Remaining personal

For patients with venous leg ulcers, telehealth – if executed properly – has the potential to significantly improve healthcare systems and patient outcomes. 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.

References

  1. McConkey R, Wyatt S. (2020) Exploring the fall in A&E visits during the pandemic. The Health Foundation. Available at: https://www.health.org.uk/news-and-comment/charts-and-infographics/exploring-the-fall-in-a-e-visits-during-the-pandemic
  2. National Health Service. (2019) Symptoms of venous leg ulcers. Available at: https://www.nhs.uk/conditions/leg-ulcer/symptoms/.
  3. 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/
  4. 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/
  5. National Health Service. (2019) Overview: venous leg ulcers. Available at: https://www.nhs.uk/conditions/leg-ulcer/
  6. 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
  7. Carver T. New study demonstrates the economic costs; medicare policy implications of chronic wounds. Available at: https://www.apwca.org/news/5310449
  8. Drew P, Posnett J, Rusling L, on behalf of the Wound Care Audit Team. The cost of wound care for a local population in England. Int Wound J 2007;4:149–155. Available at: https://pubmed.ncbi.nlm.nih.gov/17651229/
  9. 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
  10. 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
  11. Telemedicine Services Market – By Technology (Real Time, Store And Forward), By Application (Telecardiology, Telepsychiatry, Teledermatalogy, Teleradiology, Telepathology) And By Region, Opportunities And Strategies – Global Forecast To 2030. Available at: https://www.thebusinessresearchcompany.com/report/telemedicine-services-market
  12. 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