Fife CE, Carter MJ, Walker D, et al.
Wound repair and regeneration : official publication of the Wound Healing Society [and] the Eur.... Date of publication 2010 Mar 1;volume 18(2):154-8.
1. Wound Repair Regen. 2010 Mar-Apr;18(2):154-8. doi:
10.1111/j.1524-475X.2010.00571.x. Epub 2010 Feb 16.
Why is it so hard to do the right thing in wound care?
Fife CE(1), Carter MJ, Walker D.
Author information:
(1)Department of Medicine, Division of Cardiology, The University of Texas Health
Science Center, Houston, Texas 77030, USA. caroline.E.fife@uth.tmc.edu
"Doing the right thing" in wound care is not an easy task. Studies suggest that 3
factors determine compliance with performing basic wound care from an
evidence-based medicine perspective: complexity, cognitive effort, and the
compensation system. Two models were explored to investigate compliance with
basic wound care at hospital based wound centers: offloading of diabetic foot
ulcers (DFUs) and compression bandaging for venous leg ulcers. Using a very large
wound-care registry it was determined that only 6% of DFU patients received the
gold standard of care for offloading, i.e., total contact casting (TCC), but
among those patients who received it, the average cost of treatment was half the
cost of those who did not. Although inexpensive to administer, TCC is a
relatively time-consuming procedure which is poorly reimbursed. Other DFU
treatments such as bilaminate skin, are more costly but are reimbursed much more
generously. Thus, the reimbursement system favors the use of more expensive
therapies over more economical ones. In the case of venous leg ulcers (VLUs),
only 17% of patients received adequate compression. Provision of adequate
compression among VLU patients has been similarly hindered by inadequate
reimbursement policy. Lack of familiarity with clinical practice guidelines
increases the cognitive effort for clinicians. Improving the economic model to
favor the provision of effective basic care, creating easier-to-use products, and
making clinical practice guidelines available at the point of service may make it
easier to "do the right thing(s)" in wound care.
DOI: 10.1111/j.1524-475X.2010.00571.x
PMID: 20163568 [Indexed for MEDLINE]
