A comparative analysis of pressure sore treatment modalities in community settings

English:The purpose of this research project was to compare the cost-effectiveness and acceptability of an advanced wound care management method, using only Smith & Nephew™ wound care products, to that of currently used methods and/or products as encountered by the researcher in the treatment of pressure sores in the Bloemfontein community. Prior to commencement the ethical committee of the Faculty of Health Sciences, University of the Orange Free State, approved the study and its procedures. Fifty-eight patients who met the inclusion criteria (as stipulated in the research protocol) were randomly allocated to an experimental group and a control group. Patients in the experimental group were treated with Smith & Nephew™ wound care products for six weeks. Patients in the control group continued with their current treatment for the same period of time. The researcher personally performed the dressing changes of all patients in both groups free of charge. Furthermore the researcher attempted, where possible, to address all those factors that might have impeded the healing process in each patient. The characteristics and nature of each particular wound determined the frequency of dressing changes. All wounds were assessed and photographed by the researcher at weekly intervals for the six-week period. The study continued uninterruptedly for 12 months until the required sample size was achieved. The treatment methods of both groups were compared in terms of cost-effectiveness and acceptability. Analysis of the base-line data of patients on entry revealed no differences or biases between the groups and they were therefore comparable. A number of patients were withdrawn from the study as they died, moved from the geographical area, were hospitalized or became infected. Ultimately forty-one patients were included in the cost calculation.Statistical analysis of the data using 95% confidence intervals revealed no significant differences between the two groups with regard to the rate of healing and cost of treatment. However, the confidence intervals indicated the following discernable trends: o More wounds in the experimental group healed than in the control group. o The cost of treating wounds with the advanced treatment method appeared to be lower than those treated with currently used methods. o The cost to achieve healing in the experimental group tended to be lower and therefore more cost-effective. There was also a tendency for patients to find the advanced treatment using Smith & Nephew™ wound care products, more acceptable than the currently used more conventional methods. Moreover, results indicated that the advanced Smith & Nephew™ dressings were significantly more durable. The findings of this study suggest that individuals with pressure sores and their caregivers in the community stand to benefit from using advanced wound care methods, as they are appropriate, cost-effective and acceptable treatment methods for the treatment of pressure sores. Consequently the following recommendations are made: o That a wound care course open to all health care professionals on wound healing be instituted. o That a protocol for the prevention and treatment of pressure sores be developed. o That attention be given to the education of nurses with regard to clinical trial methodology. o That nurse-led clinical wound care trials be encouraged.