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Acta Vulnologica 2016 December;14(4):171-85


language: English, Italian

Chronic wounds: unmet medical needs

Luca NERI 1, Alice FATTORI 2, Sara ROWAN 3, 4, Mario MARAZZI 5, Francesco PETRELLA 6, Pasquale LONGOBARDI 7, Nedjoua BELKACEM 7, Francesca CARINI 8, Caterina TARTAGLIONE 9, Matteo TORRESETTI 9, Alessandro SCALISE 9

1 Freelance Outcome Research Consulting, Milan, Italy; 2 Department of Clinical and Community Sciences, University of Milan, Milan, Italy; 3 Clinical Scientific Support Services, Freelance Consultancy and Training, Florence, Italy; 4 University of Modena, Modena, Italy; 5 Soft Tissue Therapy Unit, Niguarda Hospital, Milan, Italy; 6 Clinic of General Surgery and Vascular Diagnostics, ASL Napoli 1, Naples, Italy; 7 Hyperbaric Center, Ravenna, Italy; 8 Civil Hospital, Piacenza, Italy; 9 Department of Plastic and Reconstructive Surgery, Ospedali Riuniti di Ancona, Marche Polytechnic University, Ancona, Italy


BACKGROUND: Patients with chronic wounds (CW) suffer from systemic and local manifestation and face higher risk of septicemia, hospitalization, and in some cases amputations. We sought to assess unmet medical needs and barriers to appropriate healthcare access for people with non-healing wounds.
METHODS: A panel of experts participated in one focus group sessions to assess their perception of CW management and outstanding medical needs. We extrapolated relevant themes with content analysis of focus group transcripts. We validated coding and categorization with an iterative process of researcher triangulation.
RESULTS: The experts agreed that current therapeutic alternatives do not satisfactorily address the un-remitting inflammation and bacterial overgrowth while restoring wound bed acidity and tissue oxygenation. The lack of dedicated setting of care and healthcare professionals with specialized competencies were considered important barriers to appropriate wound care delivery. Furthermore, cost-cutting policies from healthcare authorities leading to service rationing demands the development of new and more cost-effective treatment strategies and products. The lack of specific protocols, professional knowledge and products for patients treated in the community coupled with late referral were felt as major drivers of increased morbidity and costs.
CONCLUSIONS: This qualitative analysis highlighted several organizational, socio-economic and scientific barriers to wound care delivery and unmet medical needs. Such needs may inform the research agenda and therapeutic advancement in the field and deserve further study.

KEY WORDS: Wounds and injuries - Healthcare costs - Healthcare quality - Access and evaluation

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