The Wound Management Innovation Cooperative Research Centre (WMI CRC) was established in 2010, and is an industry led, cooperative organisation whose focus is on transforming wound outcomes by addressing the key issues affecting wound healing and prevention. Chronic wounds are an under-recognised issue in Australian healthcare, and are under-considered in terms of both research and public policy receiving little attention and investment compared to other chronic conditions
In 2014, the WMI CRC partnered with AusHSI in a large scale health economics collaboration, led by Senior Research Fellow Dr Rosana Pacella. This strong partnership has led to the successful completion of several wound management projects and publications in national and international journals.
There are four main types of chronic wounds – Diabetic Foot Ulcers, Pressure Injuries, Arterial Ulcers and Venous Leg Ulcers (VLUs). VLUs make up approximately 12% of chronic wounds diagnosed in Australia, and the key treatment for this condition is compression therapy, either through bandaging or specialised hosiery. Despite this treatment being described as optimal (and best practice), many patients do not receive it. A significant factor behind this is the high cost of these bandages – a cost currently not subsidised through Medicare or the Pharmaceutical Benefits Scheme (PBS). Dr Pacella established a wound team at AusHSI including Ruth Tulleners, Louise Barnsbee, Laura McCosker, Tamzin Pacella, PhD students Qinglu Cheng and Yuqi Zhang and health economist Dr David Brain with Dr Xing Lee providing statistical support. The AusHSI wound team also works in close collaboration with several national and international experts in wound management. A project run by Dr Pacella and her team has quantified the out-of-pocket and health system costs of the care of this condition, while demonstrating the significant cost savings to the health system that could be made with widespread use. Results such as these will be delivered to policy makers, and strengthen the case for reimbursement of compression therapy and other wound dressings and services.
Wound Innovations is the practical and clinical translation of the WMI CRC. It is a unique and innovative service, improving patient outcomes through clinical best practice, education and research. It has been operational since 2017, and AusHSI has worked closely with the clinic since its inception. AusHSI recently completed an economic evaluation of the service, measuring patient outcomes and costs prior to enrolment at the clinic, and following patient journeys for three months. Many patients attending this clinic have previously been told their wounds are unhealable, have been misdiagnosed, or are at immediate risk of amputation. Despite the severity of these wounds affecting healing times, and higher costs of this specialist clinic, preliminary results from the economic evaluation appear to indicate a benefit in accessing this model of care, both from an economic and patient outcome perspective. Unfortunately, specialist care such as this comes at a price that not all those who suffer can afford, however results such as these are being used by advocates such as Dr Pacella and team to campaign for improved access through government subsidy and reimbursement, to allow a wider group of patients in need to access this high quality care.
One of the broader projects that AusHSI has conducted during this collaboration is the organisation of a national forum in August 2017, to discuss the solutions to the many barriers chronic wound sufferers face when attempting to access best-practice care. This forum was hosted by AusHSI, in partnership with Queensland Government, Metro North Hospital and Health Service, Clinical Excellence Division, Brisbane North Primary Health Network and the WMI CRC. The forum brought together health care providers, policy makers, patients, carers and researchers from Queensland and around Australia, and the day-long event encouraged those at the coal face of wound management to share their perspectives and suggestions on what should be done to address the growing epidemic of chronic wounds in Australia. In the months following this event, further surveys, discussion and collaboration occurred to collate and refine the hundreds of suggestions into a list of specific recommendations. These recommendations were written into a document titled ‘Solutions to the Chronic Wounds Problem in Australia: A Call to Action’ – this detailed report describes recommendations in detail, along with national and international examples of how these suggested practices have been implemented successfully. The end of the document lists specific actions for all those involved in wound management, from a federal government level, down to patients and carers.
This report was launched on 15 March 2018, and has garnered widespread attention and interest from those in the wound care industry. Rosana Pacella has been invited to present the report at the Metro North Health Forum on Tuesday 19 June 2018. The report will also be presented at the Queensland Wound Awareness Week, held in July by Wounds Australia. Ruth Tulleners and David Brain will be presenting the research at the Australian Public Health conference in September, and Qinglu Cheng will present at the Wounds Australia conference in October this year. In the meantime, collaboration with the forum partners continues, and there is ongoing discussion and planning for implementing the recommendations into policy and practice. Federal Minister for Health, the Hon Greg Hunt MP, has responded, advising that he has referred wound management to the Medicare Benefits Schedule Review Taskforce for consideration.
The Wound Management Innovation CRC wraps up on the 30th of June 2018, however its partnership with AusHSI has resulted in lasting collaboration, results, publications and progress. The work of Dr Rosana Pacella and the team at AusHSI has provided a wealth of contemporary and high-quality evidence for those with the job of convincing policy makers that this very real issue deserves a lot more action than it is currently receiving.
For further information, read out call to action paper.