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Opportunities for better value wound care: a multiservice, cross-sectional survey of complex wounds and their care in a UK community population
  1. Trish A Gray1,2,
  2. Sarah Rhodes2,3,
  3. Ross A Atkinson1,2,
  4. Katy Rothwell2,
  5. Paul Wilson2,4,
  6. Jo C Dumville1,2,
  7. Nicky A Cullum1,2,5
  1. 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  2. 2 NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
  3. 3 Centre for Biostatistics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  4. 4 Alliance Manchester Business School, University of Manchester, Manchester, UK
  5. 5 Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Trish A Gray; trish.gray{at}


Background Complex wounds impose a substantial health economic burden worldwide. As wound care is managed across multiple settings by a range of healthcare professionals with varying levels of expertise, the actual care delivered can vary considerably and result in the underuse of evidence-based interventions, the overuse of interventions supported by limited evidence and low value healthcare.

Objectives To quantify the number, type and management of complex wounds being treated over a two-week period and to explore variations in care by comparing current practices in wound assessment, prevention and treatment.

Design A multiservice cross-sectional survey.

Setting This survey spanned eight community services within five Northern England NHS Trusts.

Results The point prevalence of complex wounds in this community-based population was 16.4 per 10 000 (95% CI 15.9 to 17.0). Based on data from 3179 patients, antimicrobial dressings were being used as the primary dressing for 36% of patients with complex wounds. Forty per cent of people with leg ulcers either had not received the recommended Doppler-aided Ankle Brachial Pressure Index assessment or it was unclear whether a recording had been taken. Thirty-one per cent of patients whose most severe wound was a venous leg ulcer were not receiving compression therapy, and there was limited use of two-layer compression hosiery. Of patients with a pressure ulcer, 39% were not using a pressure-relieving cushion or mattress.

Conclusions Marked variations were found in care, underuse of evidence-based practices and overuse of practices that are not supported by robust research evidence. Significant opportunities for delivering better value wound care therefore exist. Efforts should now focus on developing strategies to identify, assess and disinvest from products and practices supported by little or no evidence and enhance the uptake of those that are.

  • health services research
  • evidence based practice
  • wound management
  • healthcare value
  • healthcare quality
  • prevalence survey
  • patient-centred care

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors NAC and JCD conceived the idea and design for the overall project; TAG, KR and PW contributed to further development of the study design; TAG and KR conducted stakeholder consultation with practitioners; SR was responsible for data analysis; RAA and JCD contributed to data analysis. TAG created the original draft of the manuscript. All authors contributed to the interpretation of study findings, critical revision of the manuscript for important intellectual content and approval of the final manuscript.

  • Funding This project was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester. The NIHR CLAHRC Greater Manchester is a partnership between providers and commissioners from the National Health Service (NHS), industry and the third sector, as well as clinical and research staff from the University of Manchester.

  • Disclaimer The views expressed in this article are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Requests for access to data should be addressed to the corresponding author.

  • Correction notice This article has been corrected since it first published. The word ’and' has been removed from the name of the author in the ’Correspondence to' section.

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