Untersuchung der Qualität integrierter chronischer Wundversorgung anhand von Patientendaten des Wundzentrums Bremen

Abstract

Background: Chronic wounds are a widespread and very cost-intensive problem. An adequate care provision of chronic wounds therefore represents a big challenge both for the patients themselves as well as for society as a whole, particularly with an ageing society and the increasing cost pressure. The necessity to reinforce integrative care structures can be regarded as a very important task, especially in Germany as the division between the different health care sectors - particularly between the ambulatory and the stationary sector - is traditionally very high, which leads to meaningful losses with regard to the efficiency of the related care provision. The relevance of this issue appears even higher if chronic wounds are regarded as a major cause of morbidity in the population (Franks 2007) and if the impact of chronic leg ulceration on the patients' quality of life is taken into account.Aim: Nowadays a multidisciplinary wound care provision system is often regarded as an optimal way to improve the treatment quality and, as a result, the patient's quality of life. However, little is still known about the long-term effects on the patient's quality of life on the one hand and the medical outcomes including costs on the other hand. In this study these long-term effects were investigated by the analysis of patient data collected at a local wound care centre which opened in April 2007.Methods: Within the scope of the multidisciplinary wound care provision, data on the quality of life of patients who suffer from chronic wounds was analysed at four points in time - at the beginning, after 4 weeks, after 12 weeks and after 24 weeks - using both a generic (Nottingham Health Profile) as well as a wound-specific measuring instrument (the so called 'Würzburger Wundscore'). In addition to this, the wound documentations were analysed with regard to relevant medical parameters and costs. Throughout this approach it was possible to map long-term changes to all relevant outcome measures (quality of life, medical parameters, costs), which could be related to each other. Results: All in all, our data analysis clearly showed that if wound healing takes place, the patients` quality of life - especially the wound-specific, but, to some degree, also the overall quality of life - improves as well. The improvement was, as expected, especially high if complete wound healing was reached. The biggest problem for the patients` appeared to be, in general, pain and mobility restrictions, while psychological effects of the wound, as a social isolation in its worst case for example, occurred more infrequently in this study. The highest improvement was reached for the area of pain, while the improvement for the area of mobility turned out to be comparatively low. Especially with regard to the modest improvement of the patients` mobility, but also beyond this, it was found that the general condition of the patient has a major impact not only on the patients` quality of life, but also on the wound healing process as a whole. Another very important factor for the wound healing process and the patients` quality of life associated to this was the patients` compliance. For patients who showed a lack of compliance, the wound status showed a slight improvement in the beginning, but then changed significantly for the worse, almost back to the initial point. The results related to the patients` quality of life are in line with this. With regard to the treatment costs, not only the general condition of the patient and a complete wound healing as an endpoint turned out to be a major influencing factor. Again the patients` compliance was proved to be an important and relevant factor. Discussion: The study conducted revealed, all in all, that significant improvements towards medical outcomes and towards the patient's quality of life can be reached by the implementation of a multidisciplinary wound care provision system. In addition, considerable cost savings can be made in the long term. However, the data analysis also revealed that there was no improvement - regardless if a modern, multidisciplinary wound care provision took place - for some patients. The most important factors for the wound healing process turned out to be, as expected, the general condition of the patient as well as the patients` compliance. Therefore, a holistic approach with a major focus on pain reduction and an improvement of mobility including strategies to strengthen the patients` compliance should be pursued. Only if all of those aspects are accounted for, can a sustainable wound care provision including remarkable savings be reached.