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Abstract
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.
- burden
- cost
- pressure ulcers
- wounds
- UK
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Footnotes
Contributors JFG designed the study, managed the analyses, performed some analyses, checked all the other analyses and wrote the manuscript. GWF conducted much of the analyses. KRV and PV scrutinised the analyses, suggested further analyses, helped interpret some of the findings. All the authors were involved in revising the manuscript and gave final approval. JFG is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This analysis was originally commissioned and part funded by the National Institute for Health Research (NIHR) Wound Prevention and Treatment Healthcare Technology Co-operative (NIHR WoundTec HTC), Bradford Institute for Health Research, Bradford, West Yorkshire, UK and part funded by Smith & Nephew Medical Limited, Hull, East Riding of Yorkshire, UK.
Disclaimer The study’s sponsors had no involvement in the study design, the collection, analysis and interpretation of the data, the writing of this manuscript and the decision to submit this article for publication. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or Smith & Nephew Medical Limited.
Competing interests None declared.
Patient consent Not required.
Ethics approval Ethics approval to use anonymised patients’ records from the THIN database for this study was obtained from the Research Ethics Committee that appraises studies using the THIN database (reference number 13–061).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The THIN data set cannot be shared as this restriction was a condition of the ethics approval obtained from the Research Ethics Committee (reference number 13-061).