Improved treatment, diagnostics and greater patient participation could help to reduce both the financial and the social cost of leg ulcers in the UK.
The latest statistics on wound care in the UK identify that 420,000 of the 730,000 leg ulcers treated by the NHS in the UK each year were classified as ‘unspecified’. What the research that was published in the British Medical Journal essentially shows is that the root cause of the condition has not been identified and consequently many patients may not be receiving the optimum treatment.
“The two main type of ulcers are due to venous and arterial disease,” explains Kathryn Vowden, Lecturer and Nurse Consultant at The University of Bradford. “These are very different conditions and therefore the course of treatment for each differs widely.”
Venous leg ulcers are the most common type in the UK with 280,000 people each year being treated for the condition, which is caused by increased pressure in the veins such as in varicose veins. Treatment involves appropriate dressing alongside compression to aid healing. Arterial ulcers, on the other hand, are caused by reduced blood flow and therefore compression will inhibit healing for these patients.
“Sadly patients aren’t being assessed thoroughly,” says Professor Peter Vowden, Honorary Professor of Wound Healing Research at the University of Bradford. “Assessments are technically challenging and take longer than the 10-minute appointment slot, so we either need to make more time, or find faster assessment methods.”
For many patients, diagnostic failures not only delay the recovery process, but also mean that the root cause of the condition fails to be addressed as well, increasing the chances of recurrent ulcers and ongoing pain.
The pressures of a hugely under resourced NHS are well documented, but the financial implications of misdiagnosis are significant. Professor Vowden suggests that treating an average venous leg ulcer effectively within a year costs around £800. If the ulcer fails to heal within that time, costs can escalate up to £4,400 a year. Considering the sheer number of wound patients, that’s a considerable sum. With the right diagnosis, what are often considered ‘expensive’ treatments could improve healing and surgery could be used to prevent recurrent ulcers in some patients and ease the long-term burden and cost.
However, long-term change goes beyond simply providing an accurate diagnosis. “To truly address the issue we need improved care packages,” says Professor Vowden. “We need to consider everything from assessments, through to treatment aiming for greater patient involvement. In the long term, patient involvement could be the answer to dealing with the increased demand.”
His words are echoed by Mrs Vowden. “Public awareness is so important. If we can help people recognise the signs then they can get treatment quicker and will have fewer long term complications,” she says.
Perhaps the forgotten issue within the debate is that of a patient’s quality of life. Ulcers are a chronic condition and, as such, impact every aspect of an individual’s. Improving patients’ understanding of the condition and involving them more closely in devising solutions could lead to much improved outcomes for everyone.
Mrs Kathryn Vowden
Lecturer and Nurse Consultant at The University of Bradford
Professor Peter Vowden
Honorary Professor of Wound Healing Research at The University of Bradford