A Discourse on the Contributions of Evidence-based Medicine to Wound Care
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Although a healthcare system crippled by lack of resources cannot perform effectively, spending more money in an ineffective system may not lead to better outcomes. To ensure systemwide resource maximization, evidence-based medicine and guidelines that consider treatment cost-effectiveness and recommend treatment for persons with the most to gain are required. To demonstrate that increasing use of evidence-based medicine can improve wound care, the effect of informed treatment decisions on improving patient care was reviewed. A Medline and OvidSP literature search was conducted of English-language literature using the MESH terms evidence-based practice and wounds and injuries. The adoption of evidence-based medicine by individual healthcare professionals can help ensure the limited resources available are used efficiently, enhancing confidence that additional funds will translate into more people receiving better wound care and having better health. Wound care professionals are encouraged to participate in conducting well-designed and controlled clinical studies of wound dressings and to resist the routine use of new, usually more expensive, dressings in the absence of good quality clinical evidence for their benefit over existing products.
Key Words: review, wound care, evidence, treatments, cost-effectiveness
Index: Ostomy Wound Management 2010;56(6):48-54
Potential Conflicts of Interest: none disclosed
Dr. Al-Benna is an academic plastic and reconstructive surgeon, Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, North Rhine-Westphalia, Germany. Please address correspondence to: Sammy Al-Benna, MB ChB, PhD, MRCS, PGCNano, Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Buerkle-de-la Camp-Platz 1, 44789 Bochum, North Rhine-Westphalia, Germany; email: Sammy.Al-Benna@ruhr-uni-bochum.de.
Results of a 2009 market research study1 show that wound care is one of the most costly components of the world healthcare system. Wound care is also one of the most rapidly expanding medical device market segments for manufacturers and providers1,2 — recent worldwide industry reports1 estimate the $14 billion market in 2008 will grow 7% per year. In 2008, more than 89 million patients in the US alone were treated annually for wound conditions at costs in excess of $25 billion.2
A healthcare system crippled by a lack of resources cannot perform effectively; pouring more money into an ineffective system may not lead to better outcomes.3 However, in the context of a healthcare system with a fixed budget, it is not enough to consider the risk-benefit trade-offs of treatment. To ensure maximization of system resources, evidence-based medicine and better guidelines that consider treatment cost-effectiveness and recommend treatment for persons with the most to gain — ie, treatment for person with high risk-benefit — are required.
To demonstrate that increasing use of evidence-based medicine can contribute to a more efficient system of wound care, a Medline and OvidSP literature search of English-language publications was conducted for the MESH terms evidence-based practice (MESH H02.249) and wounds and injuries (MESH C21.866).