ghp July 2015 pdf

ghp July 2015 | 15 public health Efficient organisation of chronic wound management The increasing need to establish the most efficient care pathways is not unique to the domain of wound management. However, due to the often complex aetiology of chronic wounds and the various medical problems of individuals suffering from them, the challenges related to inefficient management have been a focus area within this domain for many years (4). Most recently, the efforts to reduce health care sector costs by moving health care services from the hospitals into community care have further stressed the need to establish clear treatment pathways for wound patients (5). Based on this outline, specific challenges related to organisation of wound management include: • Barriers to establishment of multidisciplinary teams: Chronic wounds need a careful diagnos- tic evaluation which often requires input from different specialities. Their treatment addresses a variety of underlying factors and usually in- volves different medical professions (physicians, nurses, physiotherapists, etc.). The benefit of multidisciplinary interventions for many chronic diseases (6), including wound care (7), is well proven. However, actually achieving the estab- lishment of a multidisciplinary team approach to wound care within all relevant clinical settings remains a challenge throughout Europe. • The barriers include variation in the interest and involvement of relevant medical specialities in the domain of wound care, leading to confusion as to who is responsible for different aspects of wound management. Furthermore, difficulties re- lated to implementing appropriate referral routes also present an obstacle, as do variations in the level of education within the domain of wound care. This is because the domain is not defined as an independent speciality for physicians or nurses (with a nurse specialisation in tissue viability in the UK being an exception). • The EWMA Document Managing Wounds as a Team, published in 2014 (8), proposes a univer- sal model for the adoption of a team approach to wound management. To address the challenges related to variations in the educational level of the health care professionals specialised within relevant medical specialities such as dermatolo- gists, endocrinologists as well as orthopaedic and plastic surgeons, EWMA has recently developed a curriculum for physicians which was adopted by the European Union of Medical Special- Non-healing wounds are a significant problem for healthcare systems worldwide and typically account for 2-4% of healthcare budgets. These figures are expected to rise in conjunction with an increased elderly and diabetic population (1-3). However, many of the challenges and costs related to the management of chronic wounds may be reduced by the adoption of available guidelines and recommendations for the organisation of care which are al- ready available. This article introduces the different types of chal- lenges and the initiatives taken by EWMA in order to work towards a removal of the existing barriers to improved wound management. ists (UEMS) in April 2015. EWMA is currently initiating similar activities to support a common European level in the basic education of nurses. • Challenges related to ensuring a high quality of wound management in community care: As described above, transfer of health care services from the hospitals to community care is generally supported by health care authorities. Reference to the quality of life and costs related benefits of providing patient care within the home environ- ment is taken into account. It has thus become increasingly important to ensure that health care staff members in community care settings attain the minimum skills required to deliver effective wound care and ensure that they have easy ac- cess to communication with wound specialists in the wound clinics. A recent document published by EWMA, Home Care – Wound Care, published in 2014 (5), describes these challenges and provides recommendations for how to meet them. Use of telemedicine services to support remote consultations between community care staff members and wound care specialists in the hospitals is increasing. This approach also provides the benefit of greater involvement of general practitioners and informal carers in the patients home, in addition to enhancing the role of the patient in their own care (9, 10). Inconsistent implementation of guidelines Both of these challenges related to organisation of wound management are partly connected to the fact that the available European and/or national evidence based guidelines which exist for most of the primary types of chronic wound management - Diabetic foot ulcers (11), pressure ulcers (12) and venous leg ulcers (13) - are not systematically implemented into clinical practice around Europe. Typical barriers to implementation of these guidelines include; lack of the required budget for, or management recognition of the value of evidence based guideline adoption within the given domain; that the mix or level of skills available in the group of health care staff members does not match the recommendations; lack of sys- tematic training programmes; lack of awareness that the guideline exists and or lack of communication between the health care system organisations. As the organisation and mix of competencies involved in wound management varies greatly between local treatment settings, these factors are all relevant. To address some of these challenges, EWMA is working on a document that will also address the barriers to