Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes
Objectives The aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK’s National Health Service (NHS), and the associated costs of patient management.Methods Th...
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| Language: | English |
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BMJ Publishing Group
2018-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/8/7/e021769.full |
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| author | Julian F Guest Graham W Fuller Peter Vowden Kathryn Ruth Vowden |
| author_facet | Julian F Guest Graham W Fuller Peter Vowden Kathryn Ruth Vowden |
| author_sort | Julian F Guest |
| collection | DOAJ |
| description | Objectives The aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK’s National Health Service (NHS), and the associated costs of patient management.Methods This was a retrospective cohort analysis of the records of 209 patients identified within a randomly selected population of 6000 patients with any type of wound obtained from The Health Improvement Network (THIN) Database, who developed a PU in the community and excluded hospital-acquired PUs. Patients’ characteristics, wound-related health outcomes and healthcare resource use were quantified over 12 months from initial presentation, and the corresponding total NHS cost of patient management was estimated at 2015/2016 prices.Results 50% of all the PUs healed within 12 months from initial presentation, but this varied between 100% for category 1 ulcers and 21% for category 4 ulcers. The mean time to healing ranged from 1.0 month for a category 1 ulcer to 8 months for a category 3/4 ulcer and 10 months for an unstageable ulcer. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 53% of all the ulcers may have been clinically infected at the time of presentation, and 35% of patients subsequently developed a putative wound infection a mean 4.7 months after initial presentation. The mean NHS cost of wound care over 12 months ranged from £1400 for a category 1 ulcer to >£8500 for the other categories of ulcer. Additionally, the cost of managing an unhealed ulcer was 2.4 times more than that of managing a healed ulcer (mean of £5140 vs £12 300 per ulcer).Conclusion This study provides important insights into a number of aspects of PU management in clinical practice in the community that have been difficult to ascertain from other studies, and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions. |
| format | Article |
| id | doaj-art-bfe09c98842140eeb79447b43af436c0 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2018-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-bfe09c98842140eeb79447b43af436c02025-02-01T21:15:13ZengBMJ Publishing GroupBMJ Open2044-60552018-07-018710.1136/bmjopen-2018-021769Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomesJulian F Guest0Graham W Fuller1Peter Vowden2Kathryn Ruth Vowden32 Faculty of Life Sciences and Medicine, King’s College, London, UKCatalyst Consultants, Poole, UKBradford Teaching Hospitals NHS Foundation Trust, Bradford, UK3 Bradford Teaching Hospitals NHS Foundation Trust, University of Bradford, Bradford, UKObjectives The aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK’s National Health Service (NHS), and the associated costs of patient management.Methods This was a retrospective cohort analysis of the records of 209 patients identified within a randomly selected population of 6000 patients with any type of wound obtained from The Health Improvement Network (THIN) Database, who developed a PU in the community and excluded hospital-acquired PUs. Patients’ characteristics, wound-related health outcomes and healthcare resource use were quantified over 12 months from initial presentation, and the corresponding total NHS cost of patient management was estimated at 2015/2016 prices.Results 50% of all the PUs healed within 12 months from initial presentation, but this varied between 100% for category 1 ulcers and 21% for category 4 ulcers. The mean time to healing ranged from 1.0 month for a category 1 ulcer to 8 months for a category 3/4 ulcer and 10 months for an unstageable ulcer. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 53% of all the ulcers may have been clinically infected at the time of presentation, and 35% of patients subsequently developed a putative wound infection a mean 4.7 months after initial presentation. The mean NHS cost of wound care over 12 months ranged from £1400 for a category 1 ulcer to >£8500 for the other categories of ulcer. Additionally, the cost of managing an unhealed ulcer was 2.4 times more than that of managing a healed ulcer (mean of £5140 vs £12 300 per ulcer).Conclusion This study provides important insights into a number of aspects of PU management in clinical practice in the community that have been difficult to ascertain from other studies, and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.https://bmjopen.bmj.com/content/8/7/e021769.full |
| spellingShingle | Julian F Guest Graham W Fuller Peter Vowden Kathryn Ruth Vowden Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes BMJ Open |
| title | Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes |
| title_full | Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes |
| title_fullStr | Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes |
| title_full_unstemmed | Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes |
| title_short | Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes |
| title_sort | cohort study evaluating pressure ulcer management in clinical practice in the uk following initial presentation in the community costs and outcomes |
| url | https://bmjopen.bmj.com/content/8/7/e021769.full |
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