Abstract
Today, the world is governed by metrics. In recent years there have been 2 reports from large studies done within community care in the United Kingdom 1 and the United States 2 both of which are updates on the prevalence of chronic wounds and the staggering costs associated with their care. The UK study was done on a community database (N = 1000, mean age 69 years, 45% male) with yearly new wound presentations of 76% and healing of 61% during the study year. This study identified the annual costs of care as being £5.3 billion without adjusting for comorbidity care. It identified nutritional deficiency and diabetes as independent risk factors for healing (odds ratio 0.53, P < .001) and (odds ratio 0.65, P < .001), respectively. It also stated that the care is nurse led, which may be a reason for delayed differential diagnosis. 1 The subsequent US study was done using a Medicare database. This report identified the prevalence of venous, arterial, and diabetic wounds as 2.2%, 0.4%, and 0.7%, respectively. 2 The costs of care were identified in US dollar as 569 billion (venous), 631 billion (diabetic), and 2085 billion (arterial) all of which escalate in the presence of infection. The report estimated prevalence in developed countries to be 1% to 2% of the general population. Neither the increasing prevalence (also observed in other countries) nor the staggering costs is surprising though it does beg the question are we on track for improving care or do we merely shrug and accept it as another problem of growing older?
Increased metrics and innovations have given us better, reliable diagnosis to manage chronic wounds and using these the concept of standardized care has evolved 3 though we are yet learning how to accelerate and sustain healing. We continue to scan the horizon to learn about the roles of supervised exercise and nutritional supplementation 4 in chronic wound management. Is it accepted that managing chronic wounds is best done in teams? Given that a huge proportion of patient care is community based, do hospital-based wound specialist teams enjoy close communications with their partners in the community? Could there be a wound registry within countries? Such a database could be a powerful means of persuading health care providers at national levels. Professional societies and journals could be instrumental in this development. We must master the use of metrics.