I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
Vulnerable Populations: Considerations for Wound Care
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37 Abstract: Race/ethnicity, immigration, health insurance, and literacy — along with patient-provider communication and understanding of and adherence to treatment protocols — are societal factors that affect the provision of optimal healthcare. Wound care practitioners should be aware of the need to address these factors in vulnerable groups, including the effects of racial/ethnic care disparities, immigration, low income, uninsured or underinsured status, and literacy/health literacy on health and wound care. The literature shows that care is not always perceived to be or equitably provided across different ethnic and economically diverse populations. Hence, clinicians must strive to listen to and interact non-judgmentally with vulnerable patients. Each patient’s physical and psychosocial concerns must be assessed without malice and clinicians must work with community, state, and federal agencies to enhance access to necessary services. Wound care patient teaching materials need to be developed that consider the literacy and language skills of the community served. Once the type of wound and its appropriate treatment are determined, wound care practitioners must consider patient teaching, vulnerability, cultural, and economic constraints of care, along with strategies for prevention of complications and hospitalizations.
Key Words: wound care, immigrants, low income, uninsured, health literacy
Dr. Pieper is Professor and Nurse Practitioner, College of Nursing, Wayne State University, Detroit, MI. Please address correspondence to: Barbara Pieper, PhD, CNS-BC, CWOCN, FAAN, College of Nursing, Wayne State University, 5557 Cass Avenue, Detroit, MI 48202; email: bpieper@wayne.edu.
In the United States, approximately 5 million chronically ill patients have wounds; the aggregate cost of their care has been documented at more than $20 billion annually.1 Because individuals with wounds represent varied racial/ethnic and socioeconomic groups, this high number of persons with wounds must be examined in terms of racial/ethnic diversity, poverty, immigration status, and health insurance limitations. In 2000, approximately 33% of the US population identified self as a member of racial or ethnic minority group; by 2050, these groups are projected to account for half of the US population.2 The 2007 National Healthcare Disparities Report (NHDR) used the US Bureau of the Census statistic to define poor people; in 2005, the Federal poverty threshold for a family of two adults and two children was $19,806; the number of poor Americans increased from 11.3% to 12.6% or to 37 million persons between 2000 to 2005. Racial and ethnic minorities are more likely than non-Hispanic Caucasians to be poor or near poor. Poverty by race/ethnicity group included Black/African-American (25%), Hispanic (22%), Asian (11%), and Caucasian (8%).2 The NHDR noted overall care disparities in quality and access to healthcare for minority groups and poor populations did not decline from 2000 to 2001 although progress has been made in some areas.2 The purpose of this paper is to explore US societal factors — ie, racial/ethnic disparities, immigration, low income, the uninsured and underinsured, and literacy/health literacy — that have an impact on health and wound care.
Strategies to reduce costs of wound care have included correct diagnosis, treatment appropriate to the cause and conditions of the wound, and prevention of complications and hospitalizations.3 As a way to coordinate care, the number of wound care centers has increased throughout the country. Attinger et al4 noted the success of wound care centers is based on a multidisciplinary team approach, use of evidence-based treatment protocols, efficient clinical structure, and a supportive hospital system.
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