A comparative analysis of pressure sore treatment modalities in community settings

Abstract

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 A number of patients were withdrawn from the study as they died, moved from the geographical area, were hospitalized or became infected.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.

Afrikaans:Die doel van hierdie navorsingsprojek was om die koste-doeltreffendheid en aanvaarbaarheid van 'n gevorderde wondsorg-bestuursmetode, met die uitsluitlike gebruik van Smith & Nephew™ wondsorgprodukte, te vergelyk met die metodes en/of produkte wat tans in gebruik is soos dit deur die navorser vir die behandeling van druksere in die Bloemfontein gemeenskap aangetref is. Voor die aanvang van die navorsing het die etiese komitee van die Fakulteit Gesondheidswetenskappe van die Universiteit van die Oranje-Vrystaat die studie en sy prosedures goedgekeur. Agt-en-vyftig pasiënte wat aan die insluitingskriteria, soos in die navorsingsprotokol gestipuleer is voldoen het, is ewekansig aan 'n eksperimentele en 'n kontrolegroep toegewys. Pasiënte in die eksperimentele groep is vir ses weke met Smith & Nephew™ wondsorgprodukte behandel. Pasiënte in die kontrolegroep het vir dieselfde tydperk met hulle behandeling soos voorheen voortgegaan. Die navorser het persoonlik die wonde van albei groepe versorg sonder om 'n fooi te hef. Die navorser het ook, sover moontlik, gepoog om alle faktore wat moontlik die genesingsproses by elke pasiënt kon strem, aan te spreek. Die aard en eienskappe van elke afsonderlike wond het bepaal hoe dikwels die verbindsels verwissel is. Die navorser het al die wonde elke week vir die ses-weke periode beraam en gefotografeer. Die studie het ononderbroke vir 12 maande voortgeduur totdat die verlangde steekproefgrootte bereik is. Die behandelingsmetodes van beide groepe is vergelyk in terme van koste-doeltreffendheid en aanvaarbaarheid. 'n Analise van die basislyndata van die pasiënte by toetrede het geen verskille of onewewigtigheid tussen die groepe aangetoon nie en hulle was derhalwe vergelykbaar. 'n Aantal pasiënte is aan die studie onttrek omdat hulle gesterf het, uit die geografiese streek getrek het, gehospitaliseer is of geïnfekteerd geraak het. Uiteindelik is 41 pasiënte by die kosteberekening ingesluit. Statistiese analise van die data met die gebruik van 95% vertouensintervalle het geen beduidende verskille tussen die twee groepe ten opsigte van die tempo van genesing en die koste van behandeling aangetoon nie. Die vertrouensintervalle het egter die volgende waarneembare neigings getoon: ~ Meer wonde in die eksperimentele groep as in die kontrolegroep het genees. ~ Dit wou voorkom of die koste van behandeling met die gevorderde behandelingsmetode laer was as dié met die metodes wat tans in gebruik is. ~ Die koste om genesing by die eksperimentele groep te bewerkstellig het geneig om laer en daarom meer kostedoeltreffend te wees. Daar was ook 'n neiging by die pasiënte om die gevorderde behandeling met Smith & Nephew™ wondsorgprodukte meer aanvaarbaar te vind as die konvensionele metodes wat tans in gebruik is. Verder toon die resultate dat die gevorderde Smith & Nephew™ verbindsels beduidend duursamer as die konvensionele tipes is.Die bevindinge van hierdie studie dui daarop dat indiwidue met druksere en hul versorgers in die gemeenskap voordeel kan trek uit die gebruik van gevorderde wondsorgmetodes, aangesien hulle toepaslik, kostedoeltreffend en aanvaarbare metodes vir die behandeling van druksere is. Gevolglik word onderstaande aanbevelings gemaak: ~ Dat 'n wondsorgkursus wat vir alle professionele gesondheidsorgwerkers oop is, ingestel word; ~ Dat 'n protokol vir die voorkoming en behandeling van druksere ontwikkel word; ~ Dat aandag geskenk word aan die opleiding van verpleegkundiges in die metodologie van kliniese proewe; ~ Dat verpleegkundige-geleide wondsorgproewe aangemoedig word.