Four weeks. 28 days. In most clinics, that’s only three patient visits. But, when it comes to diabetic foot ulcers, there is much to be accomplished in this very short period of time. The landmark study done by Dr. Sheehan and his associates tells us that if a diabetic foot ulcer is not 53% smaller after four weeks of treatment, there is only a 9% chance that it will heal in the next 12 weeks. There is no time for delay; a diabetic foot ulcer is, in fact, an emergency. From the time a practitioner first encounters a patient with a diabetic foot ulcer, they have four weeks to get that ulcer 53% smaller.
The Case for Evidence-Based Medicine
To accomplish this tall task, taking care to practice evidenced-based medicine is essential. Yes, our experience is important, and what we’ve learned by doing it “a million times” is noteworthy, but these lessons learned must be combined with the myriad of data, studies and literature that we have available to us. The information available to us is plentiful, and with every year that goes by, this information is more easily accessible to us than it was the year before.
Not using this information to help guide our decisions is a disservice to our field and irresponsible to our patients. It’s rare to encounter a failure rate in medicine as high as the one associated with wound care. The five-year mortality rate of a neuropathic foot ulcer is 45%. Compare that to the five-year mortality rate of colon cancer at 35%, and breast cancer at 10%. It becomes clear what a devastating problem we are dealing with and how much room there is for improvement. As wound care providers we can do better, and we can do better by practicing evidenced based medicine.
Ulcers through the Entire Continuum of Care
BSN medical offers a wide-range of tools that allows us, as providers, to see an ulcer through the entire continuum of care from beginning to end. We have many studies that establish total contact casting as the “gold standard” in healing a neuropathic foot ulcer. To name one, the study done by Nabuurs-Franssen et al. showed a healing rate of 90% in non-ischemic, neuropathic foot ulcers, with an average time to healing of just 34 days.
The BSN Cutimed Off-loader Select is a true total contact cast—the type of cast used in the study referenced above and all other studies that establish total contact casting as the gold standard. When trying to achieve the goal established by the Sheehan study of getting an ulcer 53% smaller in four weeks, there is no excuse to not use a total contact cast in patients for whom it is appropriate.
As total contact casting is the standard of care when it comes to neuropathic foot ulcers, compression is the standard of care for venous insufficiency and the ulcers associated with it.
Not all compression is created equal. As reimbursement shifts to quality-based measures, the recurrence rate of venous leg ulcers becomes even more troubling and the need to prevent recurrence becomes not only a matter of good patient care, but also a must as far as reimbursement. With this change imminent, it’s comforting to have the long-trusted JOBST brand to rely upon.
The long history of safety and efficacy that we have come to appreciate with JOBST provides us with the confidence we need to both treat these ulcers and prevent recurrence. Outcome-based reimbursement will drive value-based purchasing. This is no area to settle for anything less than the best. Healing these venous leg ulcers is often the easy part. Preventing recurrence, which has been reported as being as high as 56%, is where it gets tricky. The JOBST brand offers the continuum of care we need, allowing us to take these venous leg ulcers through healing, rehabilitation and long-term recurrence prevention—all from the same family of therapeutic solutions.
Focusing on the finances of wound care, our reimbursement model is shifting from fee-for-service to a results-driven, quality-driven model. As this becomes standard, it will be even more important from a financial standpoint to use powerful modalities with evidence to support their use to achieve excellent outcomes in a shorter period of time.
Bacterial Resistance
Another area where we, as providers, have an obligation to respect the evidence that exists is in the area of bacterial resistance. Many studies have chronicled this major problem across nearly every field of health care.
The highest scoring laboratory research poster abstract at SAWC Fall 2014, titled “Evidence of Emergent Silver-Resistance in Clinical Bacteria: A Major Implication for Wound Care and the use of Silver-Dressings” by Dr. Finley, showed us how important it is to stay abreast of new research and that the concept of, “that’s what I’ve always done,” isn’t good enough. BSN medical offers an alternative to these silver problematic dressings with Cutimed Sorbact. Indicated for colonized and infected wounds, Cutimed Sorbact binds bacteria rapidly and effectively while causing no development of bacterial resistance. It is products like this that allow us to change our practices for the better, in accordance with what the literature and recent studies mandate.
From the time you walk in a room and find a patient with a neuropathic foot ulcer, the clock is ticking. You have four weeks to get that ulcer 53% smaller. That patient keeping their leg, or even surviving, may depend on your ability to achieve that lofty goal. You owe it to yourself and to your patients to allow the multitude of data and literature we have at our disposal to help guide your care. The therapeutic solutions offered by BSN medical help us to provide our patients with products that have evidence to support their use and give us the greatest chance of success.
