Woundcare systems: Integrated approach provides uniform evidenced-based care

Key Points

This research has yielded new guidelines for integrated woundcare systems, as well as specialty care clinics.

"This integrated approach may be multidisciplinary, or it may follow an algorithm, system, pathway or guideline, but the end result is patients do better," Dr. Kirsner tells Dermatology Times.

For venous leg ulcers, Dr. Kirsner says there are some studies that show utilizing a pathway not only improves the process - meaning more people get the tests they should be getting to evaluate the venous ulcers and exclude any arterial disease - but it also reduces the associated costs.

"Both the clinical outcomes get better, so patients heal better, and it also costs less money," he says.

He adds that these results have been found in both the United States and Europe, and so the benefits seem to cross healthcare delivery systems.

"Part of the idea of this woundcare approach is that when a patient gets care, wherever they are in the U.S. or the world, ideally, the care would be similar. That is one of the benefits of having an integrated approach or pathway, where everybody kind of does more or less the same thing," Dr. Kirsner says.

Guidelines

Over the past five years, numerous organizations have instituted guidelines for integrated woundcare systems. Dr. Kirsner notes the most recent is the Wound Healing Society, a major scientific research group on wound healing, which has recently published its guidelines for all types of wounds, pressure ulcers, diabetic foot ulcers and leg ulcers.

Another organization, the Association for the Advancement of Woundcare, a major multidisciplinary clinical organization, also recently published a pressure ulcer guideline and a venous ulcer guideline, approved by the National Guideline Clearinghouse.

"The major clinical and research organizations have realized that integrated care is better than haphazard care," Dr. Kirsner says.

Specialty clinics

In the past 10 years, specialty woundcare clinics have been developed across the United States. These clinics are designed so that when patients visit the specialist, regardless of the specialty, they have a similar algorithm of care.

"The good news is you take away the specialty bias, because usually everyone looks at things from their own perspective. When you have a pathway, a system of care, then that system bypasses whether you are a surgeon or an internist or a dermatologist; you are giving that homogenous care," Dr. Kirsner says.

Individual woundcare clinics each can develop their own pathways.

"Oftentimes, they are not exactly the same, but they are all similar, because they are based on the same evidence-based literature. They stress the same points.

"A guideline tends to be disease-specific, while the woundcare pathways are often patient-oriented - meaning the patient comes into the clinic and these are the things the clinician might do to come to the diagnosis and institute therapy.

"A guideline often begins with the idea that the person has a diagnosis, and it may recommend a few things to include or exclude, but really they don't start with a patient's centric view," Dr. Kirsner says.

In the end, the concept is still the same. Homogenous evidence-based system of care is delivered, and patients do better than with a single treatment or haphazard care, he says.

Challenges

These wounds can be challenging to treat.

"Hopefully, we are doing better. There has been publication to suggest even if everything is done right - if you are treating a diabetic foot ulcer that has good arterial flow, no bone infection, well-nourished patient, etc. - still only a third to half of patients actually heal.

"So, even when you do everything right, you are still only batting 50 percent, and you definitely have to do everything right, and then sometimes you have to do more," Dr. Kirsner says.

Disclosure: Dr. Kirsner reports no relevant financial conflicts.