By Sergio Pillon, AO San Camillo-Forlanini (Rome, Italy) – VAS-European Independent Foundation in Angiology/Vascular Medicine
Healing chronic wounds (or ulcers) is one of medicine’s ongoing challenges. “De ulceribus et vulneribus capitis” from 1584 explained how hard it is to heal chronic ulcers. Today we have digital health and telemedicine to help the healing process.
The American company Woundtech is the leading physician-based provider of wound management services in the United States. They claim to have developed a unique, telehealth-driven process, proven to heal wounds faster than clinics at a lower cost, with greater patient convenience. They compared their outcomes to the Wound Registry (the traditional services) and found:
- 65% lower costs vs. competitors’ solutions;
- 95% reduction in wound-related hospital re-admission rates;
- 95% reduction in negative pressure wound therapy (NPWT);
- 99% reduction in hyperbaric oxygen therapy (HBOT);
- 33% faster healing times;
- Daily use of off-the-shelf technologies to improve results without losing safety, simplicity, clinical relevance, and contact with patient
We tested the use of telemedicine and Electronic Medical Records in our wound care unit in Rome, Italy because we believe that this could be a model for telemedicine services for every wound care unit in Italian public hospitals.
The telemedicine group, consisting of 170 subjects, (452 leg ulcers, about 23.000 dressings) was compared with a group being followed only in hospital. Both groups began their treatment as outpatients, then one group were treated using telemedicine (via e-mail and APP). We tested many dressing strategies: non-professional caregivers, nurses and the patients themselves were involved in dressing the wounds with the help of telemedicine.
We provided dressing materials; and used a SF12 health survey and a simple questionnaire to assess quality of life and “customer satisfaction” respectively. The budgeting and quality control systems of our hospital were adapted to telemedicine. In the telemedicine group, we saw a 90% wound healing rate (compared to 75% using traditional nursing methods). No hospitalization was needed (apart from some reconstructive surgery as required), In addition to a 35% global reduction in treatment costs, patients reported large improvements in their quality of life and were very satisfied with the outcome.
Following our experience, a successful telemedicine chronic wound care service requires at least:
- a clear and verified step by step strategy,
- continuous benchmarking,
- training for doctors, nurses, patients and caregivers; and
- a simple and effective dressing strategy, to ensure the best results.
The largest scientific societies on wound management in Italy, the AIUC; the EWMA (at European level) and the WUWHS at global level all have strategies for the use of telemedicine in chronic wound management. Its use to help complex cases, especially frail and old patients, provides a perfect example of the benefits of digital health.