By Emily Behse (RN, IIWCC, MClSc-WH)
Telehealth: A Solution to the Accessibility Dilemma in Wound Care
The challenges of providing holistic and timely wound care have become more apparent than ever during the coronavirus disease 2019 (COVID-19) pandemic. Individuals with chronic wounds are known to have a high prevalence of comorbidities, therefore increasing the risk for COVID-19 contraction and complications.1 All measures must be put into place to prevent such individuals from exposure to healthcare environments where the risk for contracting COVID-19 is heightened. Thus, the goal of wound healing has now transitioned in many cases from complete wound closure to the prevention of serious wound complications, in turn preventing hospitalization and surgery.2
How do we ensure individuals with chronic wounds receive continuity of care in a safe place? At these challenging times, there is no doubt that the safest place for individuals with wounds is their own homes. As a result, there has been a shift from in-person clinic visits and hospitalization to home care. COVID-19 has a clear negative impact on the diagnostic workup, hospitalization, access to Wound Care Specialists, but fortunately, the pandemic has not significantly impaired wound care provided in the comfort of their homes.3
Notably, residents of remote communities have been isolated, lacking access to complex healthcare services. A simple wound may not be viewed as an essential problem, but can most certainly become threatening to the patient’s limbs or even life. Residents of First Nation communities do not have available comprehensive health care services, which are attributed to the geographic location and financial limitations for transportation.4With a lack of available education for health care providers in remote communities on the topic of wound care, as well as a limited number of wound care specialists, the quality of care provided to patients, is compromised.
There is one solution on the rise filling these gaps in services: telehealth. With advancing technology, telehealth has become an efficient platform for education and training, quicker diagnosis of medical problems, reduced cost for the patient and healthcare system, and reduced infection risk.5 A literature review by Bondini et al6on the use of telehealth for the care of chronic wounds found that all available studies demonstrated a positive impact on wound healing with reduced healing times and positive feedback by the users.
The reduced time required for telehealth appointments versus office visits improves access to specialty services and treatments that are often in high demand for those residing in remote locations.5 These residents can now be connected to regional wound care specialists, along with the associated specialty services, to obtain comprehensive wound care without leaving their homes. This can vary from simple instruction on how to perform a dressing change correctly to screening for limb-threatening signs and symptoms.
Thus, triaging patients has become a major benefit for the use of telehealth. Both acute and chronic wounds can be a source of stress for patients and deciphering whether urgent care is required is challenging with changes to the wound. Implementing a triage system using a telehealth platform, particularly for lower extremity wounds, can quickly determine the urgency for treatment and the appropriate environment (e.g., acute care facility, outpatient clinic, or home care) required for such treatments, in turn reducing the frequency of limb amputation.7
Overall, telehealth has a variety of benefits for both the patient and healthcare provider, including:
- Increased patient satisfaction.7
- Decreased travel time and expenses.8
- Reduced waste and CO2 emissions.5,8,9
- Timely appointments.8
- Increased convenience.8
- More frequent access to healthcare professionals regardless of location.5
- Early detection of wound complications and decreased adverse events.5,7
- Workforce sustainability and decreased provider burnout.8
- Improved clinician education.5
1. Bekeny JC, Zolper EG, Steinberg JS, et al. Ensuring Quality Care in the COVID-19 Era: Applying the Donabedian Model to Tertiary Wound Care Center Practices. Journal of the American Podiatric Medical Association. 2020. doi:10.7547/20-080
2. Oropalla A. (2020). Coronavirus disease 2019 (COVID-19): Issues related to wound care and telehealth management. UpToDate. Retrieved from https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-issues-related-to-wound-care-and-telehealth-management#H3881646380
3. Schlager JG, Kendziora B, Patzak L, et al. Impact of COVID-19 on wound care in Germany. International wound journal. Published online 2021. doi:10.1111/iwj.13553
4. North West Local Health Integration Network. Regional diabetes plan [PDF]. 2016.
5. Gillman-Wells CC, Sankar TK, Vadodaria S. COVID-19 Reducing the Risks: Telemedicine is the New Norm for Surgical Consultations and Communications. Aesthetic plastic surgery. 2021;45(1):343-348. doi:10.1007/s00266-020-01907-8
6. Bondini CM, Sage S, Wilson BP, Hall MR, Wallis EAR. Modified telehealth for care of chronic wounds during the Coronavirus disease 2019 pandemic: A rapid literature review of alternative care modalities. International wound journal. 2020;17(6):1960-1967. doi:10.1111/iwj.13488
7.Oropallo A, Lantis J, Martin A, Al Rubaiay A, Wang N. Wound care during the COVID-19 pandemic: improving outcomes through the integration of telemedicine. Journal of wound care. 2021;30(Sup2):S12-S17. doi:10.12968/jowc.2021.30.Sup2.S12
8. Zhu C, Williamson J, Lin A, et al. Implications for Telemedicine for Surgery Patients After COVID-19: Survey of Patient and Provider Experiences. The American surgeon. 2020;86(8):907-915. doi:10.1177/0003134820945196
9. Said M, Ngo V, Hwang J, Hom DB. Navigating telemedicine for facial trauma during the COVID‐19 pandemic. Laryngoscope investigative otolaryngology. 2020;5(4):649-656. doi:10.1002/lio2.428